Claims Adjuster

The Remas Company; Fort Lauderdale (FL); On-site; USD 55,000 - 75,000; Full time

Job summary

The Remas Company seeks an experienced Workers' Compensation and Liability Claims Adjuster in Fort Lauderdale to analyze accidents, determine liability, and manage benefit payments.

You will interview injured employees, coordinate medical care, gather evidence, and negotiate settlements with claimants and counsel while ensuring compliance with regulations. This role requires strong investigative skills and meticulous attention to detail.

Qualifications

• Experience handling liability and workers' compensation claims.
• Ability to negotiate settlements and coordinate with medical providers.
• Strong investigative and interviewing skills.

Responsibilities

• Review accident reports and medical records to determine liability.
• Coordinate evidence gathering and statements from employees and witnesses.
• Negotiate settlements with claimants and legal teams.
• Coordinate medical treatment and payment of benefits.
• Conduct field investigations and prepare accident reports.
• Ensure timely electronic filing and CMS reporting where required.

Job description

Reviews and analyzes reports of accidents including property damage and bodily injury todetermine liability; reviews and analyzes Liability and/or Workers' Compensation claims andrecommends appropriate action.

Consults on injury cases with various medical personnel in order to ascertain the extent and cost oftreatment, loss of earning capacity and prognosis; confers with County physician on employmentlimitations.

Performs the calculation and payment of benefits whether indemnity and/or medical benefits,including entering all payments for benefits.

Coordinates the gathering of formal evidence by taking photographs, preparing diagrams and makingmeasurements at accident scene; arranges for witnesses to appear at legal proceedings,and prepares accident reports.

For Workers Compensation claims the adjuster will contact the injured employee, employer, andmedical provider to document the claim.

For Liability claims the adjuster will contact the claimant,the division and any witnesses.

Contacts injured employee, employer, and medical provider to document claim. Conducts fieldinvestigations, face-to-face statements with employees, employer representatives and witnessesto understand the nature of the claim and gain an understanding of what occurred prior to the claim.

• Negotiateclaim settlements with the Director of Risk Management, the County Administrator, theCounty Attorney, claimants and/or their legal teams. Attend mediations with the County Attorney'soffice to support the claims process.
• Provide advice regarding potential fraud, subrogation, and underwriting/safety risk, andcommunication with counsel.
• Authorizes/coordinates medical treatment with walk-in facilities and specialists to update claim.
• Analyze complex information from different sources, such as police reports, videos fromsurveillance cameras or audio, and other information to further understand the incident.
• Make decisions for approvals of medical treatments and property restoration. Make determinationson liability or compensability for Workers Compensation claims. Apportion percentage of liabilityand negotiate settlement with claimant or claimant's attorney or Liability Claims.
• Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
• Investigates liability claims, inputs data into the system association with findings.
• Calculates/processes timely disability benefits and impairment ratings of 1% or more when given to issue benefits to avoid penalties.
• Processes outgoing letters to injured employees and medical providers and places them on notice of action taking place.
• Sets up medical only claims to document/update current work status and treatment.
• Monitors/obtains discharge papers for impairment ratings and issues benefits when owed and paid within mandated timeframe to avoid penalties.
• Monitors work status for a disability of 7 days or less through discharge for closing a claim.
• Processes employee-received notices of outstanding medical bills to resolve non-payment issues.
• Reviews/corrects reporting by Center for Medicare/Medicaid Services (CMS) for accuracy.
• Denies/processes claims for non-work-related injuries with timely electronic filing to avoid penalties.
• The Workers Compensation Adjuster calculates/processes disability benefits for impairment ratingsof 1% or more when issuing benefits to avoid penalties. Sets up medical claims to document/updatecurrent work status and treatment. Monitors/obtains medical records and work status to ensure timelycalculation and payment of indemnity and impairment ratings, complete State EDI mandatedreporting within regulated time frames to avoid penalties. Processes employee-received notices ofoutstanding medical bills to resolve non-payment issues.
• Reviews/corrects reporting by Center of Medicare/Medicaid Services (CMS) for accuracy.
• For disability more than 8 days, initiates timely electronic filings to Division of Workers' Compensation.
• Conducts recorded interviews with employees and witnesses.
• Attends meetings with other Divisions, Professional Standards/Human Rights Section (PS/HRS), andHuman Resources to discuss complex claims.Performs related work as assigned.