Senior Workers' Comp Adjuster

SUMMARY

Investigates and evaluates losses while developing a plan of action to bring claims to proper resolution in a timely manner.    Experience level preferably between 5-7 years in FL Workers Compensation claims. 

JOB REQUIREMENTS:

• Confirms coverage and addresses compensability and causation on each claim
• Investigates claims, including interviewing employees, employers and witnesses
• Obtains necessary records, including but not limited to, hospital/physician records, police reports, etc.
• EDI state filings and CMS/Section 111 reporting
• Utilizes appropriate preferred vendors
• Presents thorough and accurate reports to clients and excess carriers on claims investigations/status updates
• Negotiates settlements for resolution with claimants or their attorneys
• Maintains control of litigation activities and costs per account requirements
• May be asked to mentor, train and/or share expertise with other ASC staff
• May be asked to serve as back up to supervisor or manager when they are unavailable
• Attends meetings; conferences; workshops or training sessions; and reviews written

           material to maintain current knowledge on principles, practices and new developments

           in assigned work areas

• Maintains and meets state specific licensing requirements

• Responds to client questions and comments in a courteous and timely manner
• Participates in client meetings, both telephonic and face to face
• Is responsible for catastrophic losses, complex litigation, and other sensitive issues
• All other duties as assigned

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

• Ability to understand and follow oral and/or written policies, procedures and instructions
• Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
• Ability to conduct investigations in multi-party situations
• Ability to use standard or customized software applications appropriate to assigned tasks
• Ability to prepare and present accurate, reliable and factual reports with recommendations

• Thorough knowledge of current principles and practices associated with claims investigations, adjustment and related practices
• Extensive knowledge of medical and legal terminology with a thorough understanding of

           legal principles/litigation management

• Ability to handle confidential information
• Ability to communicate effectively with others both orally and in writing
• Ability and willingness to learn quickly and utilize new skills as a result of rapidly

           changing information and/or technology

• Ability to comprehend multi-state laws and regulations to assist other offices, as necessary 

Required Experience:

Should have 5-7 years experience in handling Florida workers’ compensation claims.  A

college degree or equivalent business experience needed.