Claims Adjuster - Lost Time

Job Description

Job Description

WORKERS’ COMPENSATION CLAIMS ADJUSTER - LOST TIME

The Workers’ Compensation Claims Adjuster for Lost Time investigates, evaluates, negotiates, and concludes office handled worker’s compensation lost time claims. This position is responsible for resolving problems and answering inquires from members, providers, claimants, and their representatives.

RESPONSIBILITIES AND DUTIES

· Determines the extent of coverage of insured individuals.

· Confirm coverage with receipt of first notice of injury, and assist in establishing files with clerical assistance.

· Secure information from members, claimants, witnesses, investigating authorities, experts, doctors, attorneys, etc. using recorded statements when necessary.

· Conduct settlement negotiations via telephone and written correspondence when required. Possesses a certain level of financial authority to settle independently.

· Evaluate and conclude office handled claims within designated monetary authority.

· Review and confirm facts and other information necessary to document the file as part of the overall investigation of claims.

· Maintain diary for follow-up on files, determination of damages, and additional investigations.

· Attends any required or necessary training sessions, courses, etc. to develop and maintain up to date knowledge and skills.

· Handle SDF recoveries, subrogation recoveries, and any other recovery that may be available as a result of investigation.

· Maintains an appropriate level of confidentiality of processed information.

· Performs other related duties as required. Minimum travel as required.

KNOWLEDGE, SKILLS, AND ABILITIES

· Thorough knowledge of the applicability of relevant laws and regulations.

· Knowledge of Florida Worker’s Compensation law.

· Skill in investigating, evaluating and negotiating.

· Ability to read and interpret policy documents, technical information and procedural manuals.

· Ability to analyze all details of insurance claims and based on this analysis, make efficient and effective decisions.

· Ability to speak effectively with claimants, attorneys, etc.

· Ability to exercise independent and good judgment.

· Ability to communicate effectively to various personalities both orally and in writing.

· Ability to establish and maintain effective working relationships with department heads, managers, employees and vendors.

· Ability to manage and prioritize multiple tasks.

TRAINING AND EXPERIENCE

Graduation from an accredited college or university with a degree in Insurance, Business, or a related field; or high school diploma or GED with three to five years of experience in all aspects of Worker’s Compensation claims. Must possess a valid Workers’ Compensation Claims license.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.

**PLEASE DO NOT APPLY IF YOU ARE A SMOKER**