INSURANCE EXAMINER II - 43003112

Florida; Tallahassee (FL); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Veterans’ Preference

Travel required

Job summary

State of Florida in Tallahassee is seeking an Insurance Examiner II to conduct on-site field audits and desk audits of insurers, ensuring compliance with workers’ compensation laws and rules. The role involves analyzing claims patterns, identifying delays in payments, and reporting findings to leadership.

The position requires travel across Florida and occasional out-of-state trips, with prior experience in claims handling or insurance considered a plus.

Qualifications

• Four years of relevant experience required.
• Bachelor's degree may substitute for experience on a year-for-year basis.
• Must have a valid driver's license and be willing to travel statewide and occasionally out-of-state.
• Preference for two+ years in claims handling, medical billing, or insurance.

Responsibilities

• Conduct on-site field audits of insurers to ensure proper workers’ compensation practices.
• Perform desk audits and re-audits to monitor business practices for compliance.
• Analyze data to identify patterns of unreasonable delays and improper payments.
• Prepare and maintain audit reports and findings.
• Coordinate with Workers’ Compensation Administrator and others on violations and penalties.

Skills

Effective communication

Data examination

Problem solving

Fact-finding investigations

Record keeping & reporting

Report writing

Education

Bachelor's degree or higher

Tools

Microsoft Excel

Microsoft Word

Job description

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The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website .

Requisition No:875328

Working Title: INSURANCE EXAMINER II - 43003112

*****OPEN COMPETITIVE EMPLOYMENT OPPORTUNITY*****

CLASS TITLE: INSURANCE EXAMINER II

BUREAU: MONITORING AND AUDIT

CITY: TALLAHASSEE

COUNTY: LEON

SPECIAL NOTES:

Four (4) years of experience in a relevant field (claims handling, insurance, investigating, audit, accounting, medical billing, or business) is required. A post-secondary degree from an accredited college or university may be used as an alternative for years of experience on a year-for-year- basis.

Additional requirements:

• Licensed to operate a motor vehicle.
• This position requires extensive travel throughout the state of Florida and occasionally out-of-state.

Preference s:

• Two (2) or more years of Microsoft Excel.
• Two (2) or more years of Microsoft Word.
• Two (2) or more years of professional experience in claims handling, medical billing, or insurance.

Minimum Qualifications for this position include the following REQUIRED ENTRY LEVEL KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of the principles and techniques of effective communication.
• Knowledge of examining and evaluating data.
• Knowledge of problem-solving techniques.
• Knowledge of conducting fact-finding investigations.
• Knowledge of preparing and maintaining records.
• Knowledge of writing statistical reports.
• Ability to communicate effectively.
• Ability to understand and apply appropriate rules, regulations, policies and procedures.
• Ability to handle telephone calls and deal with the public in a courteous and effective manner.
• Ability to plan, organize and coordinate work assignments.
• Ability to travel at least two weeks every month.
• Ability to work independently.
• Ability to establish and maintain effective working relationships with others.
• Ability to perform the required position expectations.
• Ability to safely operate and rent a motor vehicle.

OTHER KSAs (Incumbent may learn on job): Knowledge of the Division of Workers’ Compensation data bases i.e., Integrated, EDI Warehouse, OFFIS, and the Centralized Performance System (CPS) Audit Module. Ability to write audit reports.

This position requires a security background check, including fingerprint as a condition of employment.

Employees of the Department of Financial Services are paid on a monthly pay cycle.

Responses to qualifying questions must be clearly supported by the state application and any omission, falsification, or misrepresentation in the answering of the qualifying questions will be cause for immediate elimination from the selection process.

BRIEF DESCRIPTION OF DUTIES:

This is work conducting on-site field audits, desk audits, and re-audits of insurers to ensure proper practices relating to workers’ compensation claims handling procedures and monitoring the business practices of insurance companies to ensure their compliance with the workers’ compensation law and administrative rules. The Insurance Examiner II is responsible for the analysis, examination and/or investigation of patterns and practices of unreasonable delay in claims handling; timeliness and accuracy of payments to injured workers and reports under sections 440.13, 440.16, 440.185, and 440.20, Florida Statutes (F.S.), and Rules 69L-3 and 69L-56, Florida Administrative Code (F.A.C.). The Insurance Examiner II is also responsible for identifying patterns and practices of harassment, coercion or intimidation of claimants as defined by Chapter 440.525(2), F.S.; ensuring compliance with medical services billing, filing and reporting under Rule 69L-7.710, F.A.C. The Insurance Examiner II assists the Workers’ Compensation Administrator and Government Consultant II in conferring with insurance company personnel and management regarding practices or possible violations of the Workers’ Compensation Law and determines penalties as required.

Monitors performance of individual insurers as required by Chapter 440, F.S. and Division Rules, using Division data systems. The Insurance Examiner II uses systems data reviews to determine timely payments of compensation to injured workers and timely filing of forms in compliance with Florida Statutes and Division Rules.

Investigates complaints assigned by the Workers’ Compensation Administrator relating to claims administrators who are non-compliant. All parties of the specific claims administrators are contacted in an attempt to resolve the issue as well as any other existing problems. Any issues that are determined to be in violation of the workers’ compensation law are documented and all parties are notified. The Insurance Examiner II continues to monitor all complaints to determine if a trend exists representing deficient claim administrator practices.

Investigates denied cases to determine questionable claims handling practices by claims administrators in accordance with Florida Statutes and Division Rules.

Investigates non-payment of orders by a judge and refers findings to the Department.

Performs other duties as required.

If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended, or deemed ineligible depending upon the date of your retirement.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.

Pursuant to Chapter 295, Florida Statutes,candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans’ Preference documentation requirements are available by clicking here . All documentation is due by the close of the vacancy announcement.

For assistance, call the People First Service Center at [phone] Monday - Friday, 8:00 a.m. to 6:00 p.m., Eastern time. Pursuant to Florida Law, 110.211 F. S., the State of Florida is an EEO employer.