Description

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Paid Days Off from Day One

• Career Development

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

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.

Schedule: Full Time

Shift : Monday - Friday

Location: 900 Hope Way Altamonte Springs, FL 32714

The role you’ll contribute:

This position is responsible for managing work related injury claims in the States of FL, CO, KS, KY, NC, TN, IL, GA, from inception to completion, that do not involve any lost time from work beyond the statutory waiting period under AdventHealth’s self-insured, self-administered workers’ compensation program and according to applicable State workers’ compensation rules and regulations. The Multi-State Medical Only Claims Specialist conducts a thorough investigation of the claim by performing a 3-point contact with the claimant, employer and medical providers within specified time frames to determine compensability and documents compensability decision in claim notes and files any required denials within statutory time frames. Requests and obtains medical reports and summarizes all medical treatment in electronic claim notes. Verifies work status and enters lost days or restricted duty information in Origami and updates as necessary. Determines, sets and documents justification for medical and expense reserves and updates as necessary. Maintains contact with the employer/facility representative and provides claim updates. Investigates claim for any subrogation potential and pursues any possible recovery. Sets detailed diaries and action plans on all files with target dates for completion of tasks. Reviews all medical bills, mileage reimbursement requests, pharmacy prescriptions and invoices for appropriateness and relationship to claim. If appropriate, approves invoices for payment and enters payment information into Origami. Reviews and completes diaries daily; maintains complete electronic file note documentation for all claim activities. Reviews medical documentation for referrals to specialists, surgical intervention, etc. Monitors claims for transfer to Lost Time Claims Specialist if claim becomes litigated and/or claimant begins losing time. Accurately enters required MMSEA data into Origami to comply with required MMSEA reporting. Submits applicable state forms within jurisdictional time frames. Actively participates in providing outstanding customer service and accepts responsibility in maintaining relationship that are equally respectful to all.

The value you’ll bring to the team:

• Completes three-point contact with employee, employer and medical provider and any witnesses (if known) within 24 hours of receiving claim.

• Requests wage statement from employer if there is anticipated wage loss

• 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

• Compensability: Conducts investigation and determines compensability within 14 calendar days and documents same in enhanced notes using enhanced note type “CD” Compensability Decision.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.

• Engages in proactive medical management of claim by authorizing appropriate medical treatment, promptly making referrals to Specialist and following claim aggressively to MMI.

• 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

• Maintains timely, complete and accurate electronic claim notes in Origami.

• Maintains all files on a diary system and completes diary tasks daily

Qualifications

The expertise and experiences you’ll need to succeed :

EDUCATION AND EXPERIENCE REQUIRED :

• 2-3 years’ experience in a workers’ compensation claims department

• High School

• Basic web navigational and computer skills required

• Origami, Riskmaster, Microsoft Office Suite, Mitchell and AWPRx software programs

• Medical terminology

EDUCATION AND EXPERIENCE PREFERRED:

• Bachelor’s degree or equivalent years of experience

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

• Successful completion of Florida Adjuster’s License (All Lines license preferred)

• Maintain State of Florida All Lines Adjuster License (if applicable) in good standing by completing required continuing education courses (5 hours law & ethics, 5 hours elective)

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category: Risk Management

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 23034819

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.