Workers’ Compensation Medical Claims Adjuster

Location: Lakeland, FL
Job ID: 31324BR
Department: Risk Management
Working Hours: 8:00 am - 4:30 pm, Monday - Friday
Pay Frequency: Weekly
Date Posted: Dec 13, 2024

$49k+

Onsite

Full Time - Regular

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Description

The Workers’ Compensation Medical Claims Adjuster investigates work-related injuries reported by Publix associates with less than eight days lost from work. They conduct thorough investigations and analysis to determine eligibility for Worker’s Compensation benefits. This involves analyzing the facts of each case in relation to the statutory requirements of each state’s worker’s compensation laws. Once eligibility is confirmed, the adjuster provides benefits and manages the claim to conclusion in compliance with state laws. If a claim is found ineligible, the adjuster communicates the denial to the associates and stakeholders.

• Conduct investigations, analyze gathered facts, and determine associate’s eligibility for Workers’ Compensation benefits.
• Prepare claims for hand-off to Lost Time Adjuster and make initial payment of lost wage indemnity benefit if needed.
• Identify claims with potential increased exposure and those requiring supervisory notification.

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Required Qualifications

• High School diploma or equivalent experience (if applicable)
• 6 months experience working in claims environment, or 12 months Publix corporate or retail experience
• Ability to obtain 6-20-General Lines Adjuster license within 6 months of employment.
• Self-direct work activities and act on tasks without direction from a supervisor.
• Set priorities, plan, and coordinate work activities,
• Willingly develop oneself.
• Work productively and effectively when faced with stressful work situations and time pressures.
• Perform arithmetic computations such as addition, subtraction, multiplication, and division correctly using whole numbers, fractions, decimals, and percentages.
• Attend to and verify the accuracy and completeness of detailed information in documents or on the computer, such as wages, fees, lists or data.
• Develop and maintain professional, trusting, positive, and productive working relationships with associates, managers, customers, and vendors.
• Create an environment in which a positive and professional service orientation is evident to internal customers.
• Use “active listening” techniques to ensure the understanding of information provided by the speaker, and display interest in the topic discussed.
• Orally present and express ideas and information clearly, politely, and concisely, in a manner appropriate to the audience.
• Prepare clear, accurate, understandable, and professional written text in English.
• Basic knowledge of Microsoft Word and Excel

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Preferred Qualifications

• Bachelor’s degree in any discipline
• One year’s prior experience in a claim setting
• Two years Publix corporate or retail experience
• Active 6-20 – General Lines Adjuster license
• Knowledge of:
  • Medical terminology, procedures, and pricing.
  • Each state’s worker’s compensation laws where we operate (AL, FL, GA, KY, NC, SC, TN, VA).
  • Each state’s worker’s compensation regulatory requirements.
  • Publix’s Return-to-Work, Leaves, FMLA HIPAA policies.
• Basic knowledge of Microsoft PowerPoint and Access
• Assure Claims processing technology.

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Benefits

• Employee stock ownership plan that contributes Publix stock to associates each year at no cost
• An opportunity to purchase additional shares of our privately-held stock
• 401(k) retirement savings plan
• Group health, dental and vision plans plan
• Paid Time Off
• Paid Parental Leave
• Short- and long-term disability insurance
• Tuition reimbursement
• Free hot lunches (buffet-style) at facilities with a cafeteria
• Visit our website to see all of our benefits: Benefits – Jobs (publix.com)

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Year End Bonus

To reward associates for their contributions to the company for the calendar year, Publix provides a Holiday Bonus in November. In the first year of continuous employment the bonus is equal to 15 hours of pay, and in the second year of continuous employment the bonus is equal to one week’s pay if associate remains employed through issue date of the bonus check. In subsequent years, the bonus is equal to two weeks’ pay.

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Additional Information

Your application may have additional steps that you will need to complete in order to remain eligible for consideration. Please be sure to monitor your email, including your spam folder, on a daily basis for critical, time-sensitive emails that could require action within 24-48 hours.

Please do not use your Publix email address when applying. Once your application has been successfully submitted you will receive a confirmation email.

Please note that Publix will not sponsor any hire for this position for a visa or permanent residence.

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