Investigating and adjusting public liability and/or Workers' Compensation claims.
Working independently under general supervision.
Reviewing and analyzing accident reports to determine liability.
Consulting with medical personnel to ascertain the extent and cost of treatment, loss of earning capacity, and prognosis.
Calculating and paying benefits, including entering all payments for benefits.
Coordinating the gathering of formal evidence such as photographs, diagrams, and measurements at accident scenes.
Contacting injured employees, employers, and medical providers to document claims.
Conducting field investigations and face-to-face statements with employees, employer representatives, and witnesses.
Negotiating claim settlements with various parties including the Director of Risk Management, the County Administrator, the County Attorney, claimants, and/or their legal teams.
Providing advice regarding potential fraud, subrogation, and underwriting/safety risk, and communication with counsel.
Authorizing or coordinating medical treatment with walk-in facilities and specialists to update claims.
Analyzing complex information from different sources to understand the incident.
Making decisions for approvals of medical treatments and property restoration.
Making determinations on liability or compensability for Workers Compensation claims.
Monitoring discharge papers for impairment ratings and issuing benefits when owed and paid within a mandated timeframe.
Setting up medical only claims to document or update current work status and treatment.
Monitoring work status for a disability of 7 days or less through discharge for closing a claim.
Processing employee-received notices of outstanding medical bills to resolve non-payment issues.
Reviewing and correcting reporting by the Center for Medicare/Medicaid Services (CMS) for accuracy.
Denying or processing claims for non-work-related injuries with timely electronic filing to avoid penalties.
Attending meetings with other divisions, Professional Standards/Human Rights Section (PS/HRS), and Human Resources to discuss complex claims.
Requires two (2) years equivalent of higher-level education from an accredited college or university with major coursework in insurance, risk management, or closely related field.
Requires four (4) years in adjusting workers' compensation and/or bodily injury/property damage liability claims or closely related experience.
Must possess a Florida All-Lines Adjuster’s License (Type 6-20 or 7-20) from the State of Florida Division of Insurance Agent and Agency Services.
Must possess and maintain a valid Florida Class E Driver's License for duration of appointment.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
Insurance, Civic and Social Organizations, and Government Administration
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