Multi State Lost Time Claims Specialist

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.

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.

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

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

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

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

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.