WORKERS' COMPENSATION SPECIALIST - 43003062

Requisition No: 838752 

Agency: Financial Services

Working Title: WORKERS' COMPENSATION SPECIALIST - 43003062

 Pay Plan: Career Service

Position Number: 43003062 

Salary:  $41,561.52 - $87,237.36 

Posting Closing Date: 10/18/2024 

Total Compensation Estimator Tool

*****OPEN COMPETITIVE EMPLOYMENT OPPORTUNITY*****

DIVISION: WORKERS’ COMPENSATION

BUREAU: FINANCIAL ACCOUNTABILITY

CITY: TALLAHASSEE

COUNTY: LEON

SPECIAL NOTES:

Four (4) years of work experience in a relevant field (financial accounting, financial reporting, bookkeeping, financial analysis, auditing) is required. A bachelor’s degree from an accredited college or university may substitute for the required experience.

Preference:

• One (1) or more years of workers’ compensation experience.
• One (1) or more years of experience auditing/adjusting workers’ compensation claims.
• One (1) or more years of experience using MS Excel and MS Word.

This position requires a security background check, including fingerprint as a condition of employment.

Regarding anticipated starting salary, the Division of Workers’ Compensation typically hires at or near the minimum, unless an incumbent possesses direct and relevant experience in the job that they are a candidate for.  The Division is prepared to negotiate the salary depending upon the candidates direct and relevant experience.

Employees of the Department of Financial Services are paid on a monthly pay cycle.

Responses to qualifying questions must be clearly supported by the state application and any omission, falsification, or misrepresentation in the answering of the qualifying questions will be cause for immediate elimination from the selection process.

Minimum Qualifications for this position include the following REQUIRED ENTRY LEVEL KNOWLEDGE, SKILLS, AND ABILITIES:

Knowledge of past and current workers' compensation law, administrative rules, fund policies and procedures, case law, medical terminology, Special Disability Trust Fund Rule 4L-10, the Workers' Compensation Reimbursement Manual and CPT Code Manual/ICD-9. Knowledge of the principles and techniques of effective communication.  Knowledge of basic arithmetic.  Ability to examine and evaluate data relating to a workers' compensation program.  Ability to understand and apply applicable rules, regulations, policies, and procedures relating to a workers' compensation program.  Ability to handle public and telephone calls in a fast, courteous, and effective manner.  Ability to work independently.  Ability to utilize problem-solving techniques.  Ability to conduct fact-finding investigations.  Ability to apply principles of logical thinking to draw valid conclusions.  Ability to plan, organize and coordinate work assignments.  Ability to communicate effectively.  Ability to establish and maintain effective working relationships with others.  Ability to perform basic mathematical calculations.  Ability to prepare and maintain records relating to a workers' compensation program.  Ability to determine the validity of reimbursement claims.

BRIEF DESCRIPTION OF DUTIES:

This is independent professional work applying expertise in all the law sets applicable to the dates of accident eligible for Fund reimbursement with a great deal of competence and accuracy; reviewing direct claims by workers’ compensation carriers for reimbursement from the Special Disability Trust Fund for the carrier’s reimbursable workers’ compensation costs on accepted claims as governed by Section 440.49, Florida Statutes. 

Review requests for claim settlement approval submitted to the Fund by carriers, self-insured employers, or their representatives. Prepare a settlement summary packet on each request for review and determination by legal and for presentation to the settlement committee.  Research and validate all the key claim data elements.  Calculate the present value of the workers’ compensation benefits to determine the reasonableness of the settlement amount being requested.  

Conduct a desk and electronic audit of each reimbursement request submitted to the Fund by carriers, self-insured employers or their representatives for workers’ compensation benefits eligible for reimbursement. Ensure each request is in compliance with the Fund offer, policies, procedures, internal controls, Florida’s workers’ compensation statute, Division administrative rules, Florida’s workers’ compensation fee schedules and applicable case law. Analyze and determine issues of medical necessity and causal connection of treatment and services provided in order to validate that the appropriate benefits and amounts were provided and paid. Participate in the claim settlement process as required.

Work directly with the carrier, self-insured employer, attorney, adjuster and claim representative. Compose correspondence to outline deficiencies or to obtain facts and supporting documentation required to resolve any discrepancies. Contact the employer/carrier in writing or by phone to answer questions regarding the claim file or the reimbursement process.  

Gain and maintain a working knowledge of applicable computer systems. Test new programs, as required, and document outcomes. Use various data sources to input and update the Fund’s database; utilize Division databases and software in the claim review and audit process.  Use the Fund’s Claims Manager database to track claim files and assignments. Exercise discretion in correcting and or referring errors to supervisor for review. Prepare claim files and correspondence for handling, scanning and disposition by the Fund’s Records Center staff.

Identify and refer claims to Supervisor/Fund Manager/Legal Staff/Bureau of Monitoring & Audit for review and action to determine compliance with Fund and Division policies and procedures. Prepare a detailed summary on same; aid in preparing files for litigation; provide testimony at depositions and hearings. Collaborate with other specialists and legal staff on multifaceted or complex issues.

Maintain working knowledge of Chapter 440, Florida Statutes, case law, applicable Administrative Rules, Division and Fund policies, procedures, manuals, reimbursement fee schedules and ICD/CPT/HCPS codes. Attend meetings and training to stay current on changes that impact the Fund’s processes.

Serves as backup for Records Center activities and performs other duties as required.

If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended, or deemed ineligible depending upon the date of your retirement.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Certain service members may be eligible to receive waivers for postsecondary educational requirements.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement.