Workers' Compensation Adjuster

Salary Range:   $48,381 - $77,894   FLSA Status: Exempt 

Purpose of Classification:

The purpose of this classification is to investigate and review workers' compensation claims, to determine and coordinate compensation and medical care, and to coordinate the employee's return to work.

 

Essential Functions:

The following duties are normal for this position.

The omission of specific statements of the duties does not exclude them from the classification if the work is similar, related, or a logical assignment for this classification.

Other duties may be required and assigned.

Determines compensability; reviews files and records; obtains statements from employee, witnesses, department supervisors, and medical providers; evaluates information gathered; and determines eligibility for compensation.

Issues indemnity benefits for lost wages and approves medical payments; analyzes, computes, and processes indemnity payments; audits incoming invoices for accuracy; requests supplier number; processes payment by determining date of injury; and enters payment and contacts into departmental computer systems.

Coordinates medical care between employee, department managers, physician, pharmacy, and legal counsel; approves prescription, physical therapy and all medical referrals; and monitors treatment plan and return to work status.

Coordinates employee's return to work; informs departments of work restrictions; assists in coordinating appropriate accommodations; completes and submits Georgia State Board of Workers' Compensation form; replies to all related requests; and ensures all required documentation is completed and distributed to appropriate parties.

Establishes reserves for wages and medication; reviews and evaluates claims files and documentation; determines length of time or approximate time of wages lost; and sets appropriate reserves according to established parameters.

Monitors changes in state and federal laws and rulings; and makes recommendations for revisions to County policies as needed.

Minimum Qualifications:

Associate Degree in Human Resource Management, Health Care Administration, or a related field required; two years experience in adjusting insurance claims, or a related field; or any equivalent combination of education, training and experience which provides the requisite knowledge, skills and abilities for this job.

Specific License or Certification Required:  Must possess and maintain a valid Georgia driver’s license; and must possess and maintain an Adjuster's License and Workers' Compensation Adjuster certification.

SUPPLEMENTAL:



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*STARTING SALARY WILL BE COMMENSURATE WITH DIRECTLY RELATED EXPERIENCE

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