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Human Resources Division
115 South Andrews Avenue, Room 508
Fort Lauderdale, Florida 33301


Class Code:W0062

INSURANCE PROCESSOR

NATURE OF WORK

This is specialized complex technical work involving the initial contact for Workers’ Compensation injuries and/or the evaluation and processing of Workers' Compensation medical and expense billings. Work involves processing bills for payment, filing State required progress reports and authorizing non-emergency medical treatment in the absence of claims examiner. Position incumbent reviews and ascertains accuracy of medical treatment charges submitted for payment and determines that such charges are in accordance with the Workers' Compensation reimbursement manual. Position incumbent receives accident/incident reports from bus operators, supervisors and police departments; maintains master files and participates in monthly Accident Review Board Meetings.

Work involves reviewing all medical bills to ascertain accuracy and determine fee to be paid in accordance with the State of Florida, Bureau of Workers' Compensation, Office of Medical Services, maximum reimbursement manual. Responsibilities also include the filing of State required progress reports, file maintenance and responding to telephone inquiries regarding the payment of bills. Work is performed with latitude for independent judgment and decision making within established policies and procedures. Supervision is provided through observation of work activities, review of bills to be processed for payment, and periodic conferences.

ILLUSTRATIVE TASKS

Evaluates medical bills on Workers' Compensation Claims for completeness and accuracy, relation of diagnosis to injury, medical necessity of procedures performed, and determines the amount to be paid in accordance with the Maximum Reimbursement Manual.

Prepares and files with the State of Florida, Bureau of Workers' Compensation required reports within the time frame required by law.

Maintains master files for all vehicular accidents/incidents; participates in monthly Accident Review Board Meetings.

Handles a large volume of telephone calls, interacting with the medical community; follows up on claimant injury, job status and duties which may be performed if placed on “Light Duty”.

Authorizes medical treatment for minor injuries in the absence of the claims examiner.

Assists employees with issues relating to County benefits; process new hires, disability and retirement under the Florida Retirement System.

Prepares payroll authorization for deductions for benefits.

Attends seminars conducted by the State in regard to continuing update of maximum reimbursement manual.

Performs related work as required.

KNOWLEDGE, ABILITIES AND SKILLS

Knowledge of Workers' Compensation claims administration.

Knowledge of current principles and practices of Maximum Reimbursement Manual.

Knowledge of the modern health and life insurance principles, practices, methods and techniques.

Knowledge of medical terminology as related to reviewing diagnostic and treatment records.

Ability to process complex claims, reporting and payment systems.

Ability to prepare and maintain fiscal records with accuracy and thoroughness.

Ability to express ideas clearly and concisely, both orally and in writing.

Ability to serve the public and fellow employees with honesty and integrity in full accord with the letter and spirit of Broward County's Ethics and Conflict of Interest policies.

Ability to establish and maintain effective working relationships with the general public, co-workers, elected and appointed officials and members of diverse cultural and linguistic backgrounds regardless of race, religion, age, sex, disability, political affiliation or sexual orientation.

REQUIRED EXPERIENCE AND TRAINING

Graduation from high school supplemented by specialized training in Workers' Compensation claims, practices and procedures; two years experience in Workers' Compensation claims or employee benefits processing as appropriate to area of assignment; or any equivalent combination of relevant training and experience.

GENERAL INFORMATION

Bargaining Unit: White Collar
FLSA Status: Non-exempt
Code of Ethics
Certification: No
Work Locations: Risk Management, Mass Transit, Human Resources
Class Spec. Estab./Revised: E6/91 R10/98

 


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