Multi State Medical Only Claims Specialist

Our Promise To YouJoining 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. All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits Schedule: Full time Shift: Day (United States of America) Address: 601 E ALTAMONTE DR City: ALTAMONTE SPRINGS State: Florida Postal Code: 32701 Job DescriptionReviews claims over 120 days monthly to ensure appropriate action plans are in place and updates action plans as necessary. Conducts thorough investigations of work-related injury claims, including three-point contact with claimant, employer, and medical providers. Determines compensability within 14 calendar days and documents decisions in claim notes. Requests and summarizes medical reports, verifies work status, and updates information in electronic claim notes. Sets and documents initial and subsequent medical and expense reserves based on anticipated expenditures. Manages proactive medical treatment authorization, referrals to specialists, and follows claims to Maximum Medical Improvement (MMI). Reviews and approves or denies medical bills, mileage reimbursement requests, pharmacy prescriptions, and invoices within jurisdictional time frames. Investigates subrogation potential by obtaining applicable reports and pursues recovery by sending lien letters to appropriate parties. Transfers claims to Lost Time Claims Specialist if litigation occurs or claimant begins losing time, and documents the transfer in claim notes. Submits required state forms within jurisdictional time frames and ensures compliance with MMSEA reporting requirements. Maintains timely, complete, and accurate electronic claim notes and files on a diary system. Completes closing activities when claims are resolved, including changing claim status and freezing payments. Performs other duties as assigned. Knowledge, Skills, and AbilitiesBasic web navigational and computer skills required [Required] Origami, Riskmaster, Microsoft Office Suite, Mitchell and AWPRx software programs [Required] Medical terminology [Required] EducationBachelor's [Preferred] High School Grad or Equiv [Required] Field of StudyAdministrative, business degree Work Experience2+ experience in a workers compensation claims department [Required] Additional InformationN/A Licenses and Certifications6-20 All-Lines Adjuster License [Required] Physical RequirementsPhysical Requirements - https://tinyurl.com/23km2677 Pay Range: $49,718.59 - $92,468.74 This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.