Multi-State Lost Time Claims Specialist in Maitland, FL at Adventist Health System Corporate Office

Date Posted: 9/10/2018

Job Snapshot

  • Job Schedule
  • Location:
    Maitland, FL
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Function
    Other Non-Clinical Professional
  • Travel
  • Shift
  • AHS Zone
    2-Legacy System
  • Organization
    Adventist Health System Corporate Office

Job Description

If you want to be a part of a place that provides nothing less than extraordinary compassionate care, then Adventist Health System is the place for you!
We are currently seeking qualified candidates for a Multi-State Lost Time Claims Specialist position that will be based in our Human Resources department. This position is based in Altamonte Springs, FL.  
This position is responsible for managing complex work-related injury claims involving lost work and restricted days and litigation in the States of FL, CO, KS, KY, NC, TN, IL, GA, from inception to completion, under Adventist Health System’s self-insured, self-administered workers’ compensation program according to applicable State workers’ compensation rules and regulations. 
Specific job duties include:
  • Completes three-point contact with employee, employer and medical provider and any witnesses (if known) within 24 hours of receiving claim.
  • Requests the wage statement from the employer if there is anticipated wage loss.  After two attempts of requesting with no success, 3rd request is to copied to the Manager and Director.
  • Contacts the facility Risk Manager or appropriate management personnel to sequester, tag and secure any equipment as evidence if it is determined that faulty or broken equipment caused the injury.  Notes the claim record of the action taken and who was notified
  • Thoroughly investigates all claims to determine compensability (causally related) within 14 calendar days and documents same in enhanced notes.  Completes and files any required forms, letters or notices on any claim involving questionable compensability within the time frames specified in each applicable jurisdiction
  • Requests and obtains medical reports, verifies work status, communicates status to employer and documents same in electronic claim notes
  • Investigates any claim for possible subrogation potential by obtaining applicable report(s), i.e. police report, lease agreements, hold harmless agreements, maintenance reports, air quality report, etc, and pursues recovery by sending a lien letter to appropriate party(s).
  • Files denial in accordance with any statutory requirements and time frames if it is determined that the claim is not compensable.      
  • Completes an initial action plan in enhanced notes within 14 calendar days of claim assignment.
  • Engages in proactive medical management of claim by maintaining ongoing contact with injured employee, employer and medical provider and reviewing and/or requesting all medical notes, reports, etc. on an ongoing basis.  Summarizes medical status in electronic claim notes using the enhanced note code “MD” for medical note.  Authorizes recommended treatment on a timely basis.  Assigns medical case management if warranted
  • Verifies work status and any specific restrictions and notifies employer of same. Contacts the facility to determine if light duty is available and if restrictions can be accommodated.  Enters lost days and/or restricted duty information in Riskmaster and updates as necessary if status changes. 
  • Maintains timely, complete and accurate electronic claim notes in Riskmaster regarding contacts, compensation, medical treatment, reserves and legal.
Experience Requirements:
  • Minimum of 5 years workers’ compensation adjusting experience and/or Manager’s discretion based on work history required
Educational Requirements:
  • Bachelor’s degree or equivalent years of experience preferred
  • Must maintain State of Florida All Lines Adjuster License in good standing by completing required continuing education courses (5 hours law & ethics, 5 hours elective)
Knowledge and Skills Required:
  • Medical terminology knowledge
  • Basic web navigational and computer skills required
  • Knowledge of Riskmaster, ImageNow, Microsoft Office Suite, Mitchell and AWPRx software programs
If this position sounds like a great match for your skills set and experience, please apply online now!

Position Location:  
Job:  Other Non-Clinical Professional
Organization:  Adventist Health System Corporate Office
Primary Location:  US-FL-Maitland
Schedule:  Full-time
Shift:  Day
Job Level:  Staff / Associate
Education Level:  High School Diploma / GED
Travel:  No
Job Posting:  Sep 10, 2018, 7:23:27 AM

Location | Organization | Category | Job Function