Medical Claim Adjuster

Medical Claim Adjuster

At FCCI, our people make the difference. Our teammates are committed to upholding FCCI's long-standing traditions of building relationships, serving others and giving back to the community. Come join us and make a difference!

We are seeking a detail-oriented and analytical Medical Claim Adjuster to investigate, evaluate, and manage assigned workers' compensation medical-only claims. In this role, you will determine compensability through thorough investigations, obtain and review medical information, evaluate coverage, establish appropriate reserves, and ensure claims are administered in compliance with applicable statutory regulations and company best practices.

The selected candidate can work from either our Sarasota, FL, Lake Mary, FL, Glen Allen, VA, Lawrenceville, GA or Ridgeland, MS office. This is a hybrid eligible role (3 days in office and 2 remote).

Key responsibilities include:

• Investigate and determine compensability for assigned medical-only workers' compensation claims in multiple jurisdictions.
• Review medical documentation and monitor treatment to ensure ongoing care is related to the work injury.
• Document claim activity, maintain claim files, and establish appropriate reserves.
• Process benefits and complete required statutory filings in compliance with applicable laws and regulations.
• Communicate with injured workers, employers, medical providers, and agency partners.
• Escalate and transfer claims as appropriate based on claim complexity and company guidelines.
• Manage claims efficiently while ensuring accuracy, compliance, and quality customer service.

In exchange for your talents, FCCI offers competitive salaries and an excellent benefits package which includes:

• Flexible Work Environment
• Paid Family Leave
• Competitive PTO & Holidays
• Recognition & Bonus Programs
• Medical, Vision, Dental & Life Insurance
• Employee Referral Bonus
• Paid Volunteer Time
• 401(k) Match & Profit-Sharing

The salary range for this position is $22.54-$34.72 hourly. This salary range is an estimate and the actual salary will vary based on applicant's education, experience, knowledge, skills, and abilities.

We are an Equal Employment Opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Please apply via our website at Drug Free Workplace (*Pre-employment drug screen is conducted for all positions)

Qualifications:

Required:

• High School diploma or equivalent
• Minimum of two years' experience in claim/medical processing work
• Basic working knowledge of relevant laws, procedures, rules and regulations.
• Solid working knowledge of claim file management techniques and processes.
• Solid working knowledge of medical terminology.
• Excellent communication, negotiation, interpersonal and organizational skills.
• Ability to explain insurance policy coverage as applicable to the area of claims handling.
• Current, active Florida Adjusters License