City of Miami ยท 2 weeks ago
CLAIMS REPRESENTATIVE
Miami, FL
Full-time
Onsite
Mid Level
3+ years exp
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Responsibilities
Receives and prepares intake information on new workers' compensation or liability claims via telephone, mail, directly from claimants, or online claim forms.
Enters data on computer to cross-reference for prior claims.
Makes initial referrals for medical treatments, authorizes medical care, disability time and payment of medical bills.
Sets up files, maintains records and conducts follow-up as required.
Reviews bills for workers' compensation benefits, medical expenses and miscellaneous expenses for conformity to medical and surgical fee schedules; may adjust charges according to established procedures; approves invoices for payment and computer input; maintains payment records on each file.
Processes medical reimbursements to employees (i.e., mileage, prescriptions).
Maintains pending files under departmental regulations.
Communicates with departments on medical and work status of injured employees. Follows up with employees on return to work, light duty, modified duty or regular duty.
Communicates with physicians for special referrals and obtains authorization for physical therapy.
Confers with Claims Supervisor, Claims Adjustors and legal staff as to compensability of claims.
Prepares files, which go into litigation for follow-up investigation.
Qualification
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Required
High school diploma or its equivalent
Three (3) years clerical experience in areas of risk management
Two (2) years experience in working effectively with the public
Equivalent combination of education and experience beyond a high school diploma or its equivalent and two (2) years of the required experience
Proof of education in the form of a high school diploma or its equivalent
Foreign diplomas/degrees must be submitted with a credential evaluation report from an approved credential evaluation agency
Translations of diploma/degrees are not accepted
If degree/diploma does not reflect the academic major on its face, transcripts indicating degree completion must be submitted
Audit/Academic reports are not accepted as substitutions for college transcripts
For additional list of approved credential evaluation agencies visit the Florida Department of Education
Applicants must provide a valid email address in order to receive notification of eligibility
Applicants must completely detail their work experience on the employment application or risk being disqualified
It is the applicant's responsibility to ensure that all required documents submitted with the employment application are in a format that is acceptable, clear and legible for eligibility determination or risk being disqualified
Company
City of Miami
The City of Miami is the seat of Miami-Dade County, the most populous county in Florida located in between the Everglades and Biscayne National Parks.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Cheriene Floyd
Chief Data Officer
Gee Ming Chow, CGCIO, MBA/MSF
Chief Information Officer (CIO) - IT Director
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