Worker's Compensation Claims Adjuster II - (Working Title Risk Analyst) - Human Resources

County Of Volusia Deland , FL 32723

Posted 2 months ago

Major Functions

The County of Volusia is seeking a Workers' Compensation Claims Adjuster II - Working Title RiskAnalystfor the Human Resources Division. This is position is located in Deland, Florida and must be able to travel to various work locations throughout Volusia County based upon operational needs.TheRisk Analystis responsible for analyzing medium to complex workers' compensation claims to determine benefits due and working with mid to high exposure claims involving litigation and rehabilitation. This position ensures ongoing adjudication of claims within county standards and industry best practices, and identifies subrogation of claims, and negotiates settlements.

Illustrative Duties

(Note: These are intended only as illustrations of the various type of work performed. The omission of specific duties does not exclude them from the position.)

  • Analyzes and processes medium to complex workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

  • Negotiates settlement of claims within designated authority.

  • Manages the litigation process; participates in depositions, and ensures timely and cost effective claims resolution.

  • Files responses to petitions for benefits.

  • Reports claims to the excess carrier; responds to requests for directions in a professional and timely manner.

  • Coordinates vendor referrals for additional investigation and/or litigation management.

  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.

  • Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.

  • Calculates and pays benefits due; approves and makes timely claim payments and adjustments.

  • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

  • Prepares necessary state fillings within statutory limits.

  • Communicates claim activity and processing with the claimant; maintains professional relationships with the claimant, county staff, and vendors.

  • Ensures claim files are properly documented and claims coding is correct.

  • Refers cases as appropriate to supervisor and management.

  • Maintains and works an electronic diary with future tasks for each claim and perform the tasks timely.

  • May be assigned to other county locations based upon operational needs.

  • Attends work on a regular and consistent basis.

  • Responds to emergency situations.

  • Adheres to Federal, State, County and Local ordinances.

  • Performs other duties as assigned.

Minimum Requirements

Education: Bachelor's degree from an accredited college or university.

Experience/Training/Certifications:Three (3) years of workers' compensation claims management experience handling medical only and lost time cases.

A comparable amount of related education, training and experience may be substituted for the minimum qualifications.

License:Must possess and maintain Florida All-Lines Adjuster license.

Must possess a valid driver's license at time of hire.

Must obtain a valid Florida driver's license within 30 days of hire and maintain thereafter.

The preferred candidate, having met the minimum qualifications, holds a Board Certified Workers Compensation Professional (WCCP) certification and maintain thereafter.

Knowledge, Skills & Abilities

  • Strong knowledge of Florida workers' compensation statutes, cost containment principles including medical management practices, claim and disability duration, and Social Security set asides.

  • Knowledge of procedures, forms, and policies relating to filing and resolving workers' compensation claims.

  • Knowledge of Electronic Data Interchange (EDI) reporting processes.

  • Computer literate to include use of Microsoft Office Suite programs (Word, Excel, and PowerPoint).

  • Strong analytical, interpretative, and problem solving skills.

  • Excellent negotiation and interpersonal skills.

  • Clear and conceptual thinking and ability to exercise good judgment.

  • Ability to communicate effectively, both orally and in writing.

  • Ability to work in a team environment.

  • Ability to work in a professional nature with claimants, attorneys, county staff, and general public.

  • Must be able to relocate to other county locations based upon operational needs.

ADA REQUIREMENTS:

Physical Demands:Ability to perform essential duties and responsibilities, and meet the minimum qualifications. Primarily sedentary work. Ability to lift, carry, push and/or pull ten (10) pounds. Visual acuity (peripheral vision, depth perception) necessary to operate a motorized vehicle. Ability to see, hear, talk, feel, reach. Finger dexterity.

Environmental Demands: Primarily inside work.

Mental Demands:Ability to read and comprehend rules, regulations, policies and procedures; ability to read and comprehend legal documents and statutes. Ability to write complex reports detailing opinions, findings and actions. Ability to perform complex mathematical calculations. Ability to speak clearly and concisely; publicly.

Volusia County is a drug free workplace and an Equal Opportunity Employer committed to a diverse workforce. Veterans' preference in accordance with federal, state, local laws.

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Worker's Compensation Claims Adjuster II - (Working Title Risk Analyst) - Human Resources

County Of Volusia