This is advanced specialized professional, technical, managerial and administrative work in the development and management of the County’s Self Insured Workers’ Compensation Section administered by the Risk Management Division.
Work involves responsibility for developing and managing the activities of a
Self Insured Workers’ Compensation Program for over 14,000 covered employees in accordance with Florida State Statue 440 and all associated rules and regulations. Work involves supervising professional, paraprofessional and clerical support staff of the section.
Assignments are received in the form of broad policy directives and organizational goals. Work is performed with considerable independence and initiative and is reviewed by the Assistant Director/Claims Manager through conferences, reports and observation of results achieved.
Manages the operations of the County’s Self Insured Workers’ Compensation Section; directs thru subordinates the planning, scheduling and coordination of all Workers’ Compensation claims adjusting activities.
Establishes “best practices” procedures for claims administration; provides training to subordinate adjusting staff; and ensures compliance with the established procedures.
Provides technical expertise to in-house adjusting staff in all aspects of workers compensation claims administration laws, rules, regulations and practices.
Reviews complex claims and recommends appropriate action and adjusts complex cases as necessary.
Establishes claim reserving practices to ensure that claims are adequately reserved; performs periodic claim audits.
Coordinates defense preparation with County’s defense attorneys; attends and assists at legal depositions, hearings and mediations
Coordinates all excess workers’ compensation claims with the various excess insurance carriers.
Coordinates claim settlement Board Agenda items to ensure timely settlement of claims.
Ensures that Risk Management meets all State of Florida Workers’ Compensation claims reporting including all Electronic Data Interchange (EDI) mandates; stays abreast of and communicates to in-house claims administration system technical staff any and all needed changes to the claims system in order to meet State reporting requirements including EDI.
Keeps abreast of legislative proposals and amendments as it relates to Workers’
Compensation for impact on the County’s Self Insured Fund and on benefits for covered employees.
Prepares and delivers oral presentations to County agencies and upper management regarding Workers’ Compensation rules, regulations, polices and procedures.
Serves as Project Manager for the procurement of 3 rd party Workers’ Compensation Services, i.e. Medical Network Provider, Private Investigations, Excess Workers’ Compensation Coverage, etc.
Trains section employees and employees of other County divisions on State and
County rules and regulations regarding workers’ compensation.
Attends conferences, workshops and professional meetings to ascertain new developments and/or changes in Workers’ Compensation laws, polices and procedures.
Prepares and distributes complex oral, written and statistical reports
Performs related work as required.
KNOWLEDGE, ABILITIES AND SKILLS –REQUIRED AT TIME OF HIRE ( Applicants are expected to posses the required Knowledge, Abilities and/or Skills listed below prior to being hired for the position in this job title:
Thorough knowledge of Florida Statue 440 Workers’ Compensation Law and all reporting requirements.
Thorough knowledge of all federal, state and local regulatory requirements
pertaining to Workers’ Compensation claims.
Thorough knowledge of investigative and adjustment techniques, procedures and
practices involving Workers’ Compensation claims.
Thorough knowledge of medical terminology as required for reviewing diagnostic and treatment records/reports.
Thorough knowledge of HIPAA’s privacy and security requirements as they pertain to protected health care information
Thorough knowledge of principles of supervision, organization and administration.
Considerable knowledge of automated claims administration systems.
Ability to analyze facts and exercise sound judgment in investigating claims and in the settlement of claims.
Ability to plan, organize and coordinate work of subordinate professional, paraprofessional and clerical support staff.
Ability to communicate clearly and concisely both orally and in writing.
Ability to keep and maintain records and to prepare and submit accurate reports
Ability to serve the public and fellow employees with honesty and integrity in full accord with the letter and spirit of BrowardCounty'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, color, religion, age, gender, ethnicity, disability, sexual orientation, martial status or political affiliation.
REQUIRED EXPERIENCE AND TRAINING
Graduation from High School supplemented by college level course work in insurance, however, a Bachelor’s degree with major course work in Insurance and Risk Management or Business Administration or other closely related field is preferred. A minimum of six (6) years experience in investigating and adjusting workers’ compensation claims of which at least three (3) years must be in Florida; a minimum of three (3) years supervisory and managerial experience in workers’ compensation; or any equivalent combination of relevant training and experience.
NECESSARY SPECIAL REQUIREMENT
Possession and retention of a Florida Workers’ Compensation Adjuster’s License or a Florida All Lines Adjuster License.
Possession and retention of a valid State of Florida Driver’s License
Bargaining Unit: Unrepresented
FLSA Status: Exempt
Code of Ethics
Class Spec. Estab ./Revised: E10/98 - R11/07