Multi State Lost Time Claims Specialist

AdventHealth; Florida; On-site; USD 55,000 - 103,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Disability insurance

PTO from Day One

403-B retirement plan

Parental leave

Job summary

AdventHealth in Florida is seeking a seasoned Workers' Compensation Claims Adjuster to manage complex injury claims from inception to closure. You will investigate, coordinate with workers and employers, and liaise with legal counsel as needed.

The role requires reviewing medical reports, wage statements, and calculating compensation; you will also approve settlements within authority and ensure system accuracy for submissions.

Qualifications

• Medical terminology knowledge required.
• Proficiency with core claims software tools listed.
• Bachelor's degree preferred; high school diploma required.

Responsibilities

• Manages complex work-related injury claims from inception to completion, including lost work, restricted days, and litigation.
• Conducts thorough investigations and gathers necessary information for each claim.
• Communicates with injured workers, employers, and legal counsel regarding claim status and transfers.
• Reviews medical reports, wage statements, and related documents.
• Calculates average weekly wages and compensation rates; justifies reserves.

Skills

Medical terminology knowledge

Basic computer skills

Education

Bachelor's degree (preferred)

High School Grad or Equivalent (required)

Tools

Origami

Riskmaster

Microsoft Office Suite

Mitchell

AWPRx

ImageNow

Job description

Our promise to you

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule

Full time

Shift

Day (United States of America)

Address

900 HOPE WAY

City

ALTAMONTE SPRINGS

State

Florida

Postal Code

32714

Job Description

Responsible for managing complex work-related injury claims involving lost work and restricted days and litigation from inception to completion. This position conducts thorough investigations, communicates claim transfers to injured workers, employers, and legal counsel, and reviews medical reports and other file documentation. This role also requests wage statements, calculates average weekly wages and compensation rates, and determines, sets, and documents justification for medical, expense, legal, and indemnity reserves.

• Manages complex work-related injury claims from inception to completion, including lost work, restricted days, and litigation.
• Conducts thorough investigations and gathers necessary information for each claim.
• Communicates with injured workers, employers, and legal counsel regarding claim status and transfers.
• Reviews medical reports, wage statements, and other documentation related to the claim.
• Calculates average weekly wages and compensation rates for injured workers. Determines, sets, and documents justification for medical, expense, legal, and indemnity reserves.
• Reviews and approves medical bills, mileage reimbursement requests, pharmacy prescriptions, and invoices for appropriateness and relationship to the claim. Manages litigation by corresponding with legal counsel, attending depositions, mediations, hearings, or trials, and approving settlements within settlement authority levels.
• Ensures accurate completion of all required fields in the claims management system for successful submission.
• Provides regular updates and reports on claim status to relevant stakeholders. Performs other duties as assigned.

Knowledge, Skills, and Abilities

• Basic web navigational and computer skills [Required]
• Medical terminology knowledge
• Proficiency in Origami, Riskmaster, Microsoft Office Suite, Mitchell, AWPRx, and ImageNow software programs

Education

• Bachelor's [Preferred]
• High School Grad or Equivalent [Required]

Work Experience

• 2+ years of multi-jurisdictional experience [Preferred]
• 5+ years of workers compensation adjusting experience and/or managers discretion based on work history [Required]

Licenses and Certifications

• 6-20 All-Lines Adjuster License [Required]

Physical Requirements

Physical Requirements - https://tinyurl.com/23km2677

Pay Range

$55,224.00 - $102,731.20

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida's background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.