Workers' Compensation Medical Claims Adjuster

Publix Super Markets; Lakeland (FL); On-site; USD 50,000 - 80,000; Full time

Benefits offered by this job

Employee stock ownership plan

401(k) retirement savings plan

Group health, dental and vision plans

Paid Time Off

Paid Parental Leave

Short- and long-term disability保险

Tuition reimbursement

Job summary

Publix Super Markets, Inc. is seeking a Legal & Risk Management investigator to assess work-related injuries with under eight days lost. You will analyze state-specific workers’ compensation laws, determine eligibility, and manage benefits through to resolution.

This role requires independent judgment, attention to detail, and strong communication with stakeholders. You will handle claim investigations, prepare hand-offs to Lost Time Adjusters, and may initiate early wage indemnity payments when

Qualifications

• High School diploma.
• Six months experience in a claims environment or 12 months Publix retail experience.
• Ability to obtain 6-20 General Lines Adjuster license within six months of employment.
• Initiative and strong planning and organizing skills.
• Self-development and stress-tolerance.
• Attention to detail and arithmetic computation.
• Strong verbal and written communication and interview skills.
• Proficiency in MS Word and Excel.

Responsibilities

• Investigate work-related injuries reported by Publix associates involving less than eight days lost from work.
• Analyze facts to determine eligibility for Worker’s Compensation benefits under state laws.
• Manage claim activity and communicate decisions to stakeholders.
• Prepare claims and hand off to Lost Time Adjuster; initiate first payment of lost wage indemnity when applicable.
• Identify high-exposure claims and communicate supervisory needs.

Skills

Active Listening

Verbal Communication

Written Communication

Interviewing skills

Investigative skills

Detail Orientation

Planning and Organizing

Stress-Tolerance

Customer Focus

Arithmetic Computation

Building Relationships

Initiative

Education

High School diploma

Bachelor’s degree in any discipline

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Microsoft Access

Assure Claims

Job description

Description The purpose of this position is to investigate work-related injuries reported by Publix associates involving less than eight days lost from work. The proper investigation and analysis are necessary to determine eligibility for Worker’s Compensation benefits. Eligibility is determined by analyzing the facts surrounding each case and how that compares to the statutory eligibility requirements of each state’s unique set of worker’s compensation laws. Once eligibility is confirmed, the incumbent then provides benefits and manages that claim to conclusion in accordance with each individual state’s laws. If it is determined that a case is not eligible for benefits, the case is denied, and this determination is communicated to the associates and other stakeholders. Primary Responsibilities

• This position is responsible for conducting investigation, analyzing the facts gathered from that investigation, determining if the associate is eligible to receive Worker’s Compensation benefits, and if so, analyzing those statutory provisions for each specific jurisdiction. The incumbent exercises independent judgement to determine the extent of investigation and how to conduct it, interpret those facts in conjunction with each state’s unique Worker’s Compensation law and eligibility requirements to arrive at a decision.
• This position is responsible for managing the overall claim activity or the associate is discharged from further medical care.
• This position is responsible for preparing claim and hand-off to Lost Time Adjuster and making the first payment of lost wage indemnity benefit to the injured worker should a claim originally reported as medical only result in more than seven days of lost time from work, or the associate secures legal representation.
• This position is responsible for identifying claims that may cause increased exposure as well as those that required supervisory notification.

Department Legal & Risk Management Job Category Legal & Public Affairs Description The purpose of this position is to investigate work-related injuries reported by Publix associates involving less than eight days lost from work. The proper investigation and analysis are necessary to determine eligibility for Worker’s Compensation benefits. Eligibility is determined by analyzing the facts surrounding each case and how that compares to the statutory eligibility requirements of each state’s unique set of worker’s compensation laws. Once eligibility is confirmed, the incumbent then provides benefits and manages that claim to conclusion in accordance with each individual state’s laws. If it is determined that a case is not eligible for benefits, the case is denied, and this determination is communicated to the associates and other stakeholders. Primary Responsibilities

• This position is responsible for conducting investigation, analyzing the facts gathered from that investigation, determining if the associate is eligible to receive Worker’s Compensation benefits, and if so, analyzing those statutory provisions for each specific jurisdiction. The incumbent exercises independent judgement to determine the extent of investigation and how to conduct it, interpret those facts in conjunction with each state’s unique Worker’s Compensation law and eligibility requirements to arrive at a decision.
• This position is responsible for managing the overall claim activity or the associate is discharged from further medical care.
• This position is responsible for preparing claim and hand-off to Lost Time Adjuster and making the first payment of lost wage indemnity benefit to the injured worker should a claim originally reported as medical only result in more than seven days of lost time from work, or the associate secures legal representation.
• This position is responsible for identifying claims that may cause increased exposure as well as those that required supervisory notification.

Required Qualifications

• High School diploma
• Six months experience working in claims environment or 12 months Publix retail experience.
• Ability to obtain 6-20-General Lines Adjuster license within six months of employment
• Initiative
• Planning and Organizing
• Self-Development
• Stress-Tolerance
• Arithmetic Computation
• Detail Orientation
• Building Relationships
• Customer Focus
• Active Listening
• Verbal Communication
• Written Communication
• Interviewing skills
• Investigative skills
• Microsoft Word
• Microsoft Excel

Preferred Qualifications

• Bachelor’s degree in any discipline
• One years prior experience in a claim setting
• Two years Publix retail experience
• Currently hold a 6-20 – General Lines Adjuster license
• Knowledge of medical terminology, procedures, and pricing.
• Knowledge of each state’s worker’s compensation laws where we operate.
• Knowledge of each state’s worker’s compensation regulatory requirements.
• Knowledge of Publix’s Return-to-Work, Leaves, FMLA HIPAA policies.
• Microsoft PowerPoint
• Microsoft Access
• Assure Claims

Benefits Information

• Employee stock ownership plan that contributes Publix stock to associates each year at no cost
• An opportunity to purchase additional shares of our privately-held stock
• 401(k) retirement savings plan
• Group health, dental and vision plans plan
• Paid Time Off
• Paid Parental Leave
• Short- and long-term disability insurance
• Tuition reimbursement
• Free hot lunches (buffet-style) at facilities with a cafeteria
• Visit our website to see all of our benefits: https://jobs-beta.publix.com/benefits/

Year End Bonus To reward associates for their contributions to the company for the calendar year, Publix provides a Holiday Bonus in November. In the first year of continuous employment the bonus is equal to 15 hours of pay, and in the second year of continuous employment the bonus is equal to one week’s pay if associate remains employed through issue date of the bonus check. In subsequent years, the bonus is equal to two weeks’ pay. Additional Information Your application may have additional steps that you will need to complete in order to remain eligible for consideration. Please be sure to monitor your email, including your spam folder, on a daily basis for critical, time-sensitive emails that could require action within 24-48 hours. Please do not use your Publix email address when applying. Once your application has been successfully submitted you will receive a confirmation email. For this position, Publix does not and will not file a petition or application with the USCIS or Department of State on behalf of any noncitizen for any immigration-related benefit to work and/or to continue to work in the United States, e.g., an H-1B or TN petition or permanent residence.