Workers' Compensation Medical Claims Adjuster

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

Hours of Work

8:00 am - 4:30 pm; Monday - Friday

Travel Frequency

0%

Details

Compensation Type: Hourly Paid

Frequency of Pay: Weekly

Minimum Base Pay: 25.00

Maximum Base Pay: 34.50

Potential Annual Base Pay: 52,000 - 71,760

Address: 3300 Publix Corporate Parkway

City: Lakeland

State: Florida

Zip Code: 33811-3311