Workers' Compensation Excess/SDF Claims Specialist (Remote)

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: WC Claims Supervisor

Compensation: $45,000 - $60,000 / year

Description

Key Responsibilities

• Coordinate with all clients and/or their insurance agents to ensure excess insurance policies and declaration pages are available for each year with open claims, maintained in the master account files
• Provide timely notification/correspondence to each client’s excess carrier identifying that we have been retained to provide Third Party Administration services, and our usual procedures for reporting a claim to the excess carrier
• Identify to the appropriate claim supervisor(s), claims specialist(s) and IS Dept the retention levels for each excess insurance policy period(s) and all special reporting requirements identified by the excess carrier that are in addition to usual excess reporting requirements.
• Provide required reporting of all claims to the appropriate excess carrier as follows: the Initial Notice of a claim to the excess carrier with specific details, copies etc., Follow-up/Supplemental Reports on each claim diaried to be completed within the follow-up reporting guidelines as established by each excess carrier (i.e., 90 days/180 days, etc.), assist the Claims Specialist with settlement authority from the appropriate excess carrier on claims that will reach the Self-Insured Retention level (SIR), provide copies of the settlement documentations to the excess carrier with the Final Report
• Maintain communication with claims specialists and supervisors re. handling of excess reporting to ensure all claims that meet excess insurance criteria are reported to the excess insurance carriers in a professional and timely manner
• Evaluate files for SDF potential and aggressively pursue to meet the State’s requirements for successful Fund reimbursement
• Contact with employers, attorneys, field representatives and doctors in timely manner
• Notify SDTF of all potential settlements on SDF cases and advise claims specialists of the Fund’s settlement approval procedures
• Ensure all file handling includes consistent system documentation and timely compliance of all State reporting
• Maintain file diary. Keep all files current according to company standards
• Correspond with excess carriers and the SDTF regarding excess/SDF issues
• Update SDF status reports to certain clients on a quarterly basis, and excess status reports to the excess carriers on a 3-, 6- or 12-month basis on certain accounts.
• Provide SDTF with initial and annual reimbursement requests
• Monitor on diary, complete SI-19 forms and facilitate customer execution and timely filing with FLDFS
• ·Perform other duties as assigned.

Skills, knowledge & expertise

• 1-2 years of claims-handling experience in Florida WC law.
• 1-2 years of office experience.
• Active Adjuster license (FL 5-24 or 5-20/6-20).
• Working knowledge and experience handling Workers’ Compensation claims.
• Knowledge of state-specific Workers’ Compensation statutes.
• Ability to effectively operate a personal computer and related claims and business software. 
• Good communication skills, both oral and written; good customer service skills.
• Excellent organizational skills. Team player. Good attendance.

Equal Employment Opportunity & Legal Notices

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
• Paid holidays
• Life insurance and short‑term and long‑term disability coverage

• Maintain regular and dependable attendance.
• Be available and able to perform job responsibilities during established work hours.