Job Description

Requisition No: 874481

Agency: Financial Services

Working Title: WORKERS' COMPENSATION SPECIALIST - 43003070

Pay Plan: Career Service

Position Number: 43003070

Salary: $42,561.57 - $88,982.08

Posting Closing Date: 05/06/2026

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

CLASS TITLE: WORKERS’ COMPENSATION SPECIALIST

DIVISION: WORKERS’ COMPENSATION

BUREAU: MONITORING AND AUDIT

CITY: TALLAHASSEE

COUNTY: LEON

Four (4) years of experience in a relevant field (risk management, insurance, claims handling, medical billing and reporting, financial accounting, or auditing) is required A post-secondary degree may be used as an alternative for years of experience on a year-for-year basis.

Preferences:

• One (1) or more years of experience in workers’ compensation.
• One (1) or more years of professional experience in claims handling, medical billing, or insurance.
• Two (2) or more years of experience using Microsoft Word.
• Two (2) or more years of experience using Microsoft Excel.

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

Knowledge of the principles and techniques of effective verbal and written communication. Ability to perform basic mathematical computations. Ability to handle 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 plan, organize and coordinate work assignments. Ability to communicate effectively. Ability to establish and maintain effective working relationships with others. Ability to prepare and maintain records relating to a workers' compensation program. Ability to negotiate and facilitate resolution agreements.

OTHER KSAs (Incumbent may learn on job): 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.

SPECIAL NOTES:

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.

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

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.

BRIEF DESCRIPTION OF DUTIES

The Workers’ Compensation Specialist under limited supervision performs specialized investigations, examining and analyzing the case management system in the Permanent Total Section of the Monitoring and Audit Bureau. Workers’ Compensation Specialist responsibilities include authorizing and calculating permanent total disability benefits to eligible injured workers, which are paid from the W.C. Administration Trust Fund. The Workers’ Compensation Specialist is also responsible for determining and applying various factors involving the amount of benefits due to injured workers: such as offsetting social security payment, joint petitions stipulation settlements and other judicial orders. The Workers’ Compensation Specialist is responsible for educating, training and answering inquiries regarding PT benefits. The Workers’ Compensation Specialist also seeks to resolve disputes and help reduce litigation. This position is responsible for conducting on-site field audits, desk audits and re-audits of insurers.

The Workers’ Compensation Specialist uses independent judgment in the interpretation, application and enforcement of Florida Workers’ Compensation Laws, Division rules, policies and procedures.

1. Examine and monitor cases to prevent or rectify overpayment or fraudulent receipt of payments. Investigates permanent total cases for possible fraud or overpayment. Reports fraudulent cases to the concerned authorities for action.
2. Investigate workers’ compensation claims when a request for permanent total supplemental benefits is made.
3. Determines, calculates and authorizes PT payments. Applies social security offset against benefits whenever applicable in accordance with appropriate statutes and case law.
4. Provides assistance and answers questions relating to the Workers’ Compensation Law and claims handling procedures, from attorneys, insurance company representatives, employers, employees and health care providers via the toll-free lines and regular telephone lines.
5. Prepares case records and handles all follow up activities pertaining to recoupment of overpayment.
6. Appears for depositions and testifies at hearings as a part of the examining and monitoring function.
7. Assists injured workers in applying for social security disability benefits from social security administration, in accordance with Florida Workers’ Compensation Statutes.
8. Contacts injured workers to obtain Employee Earning Reports (DWC-19) on an annual basis.

Monitors PT cases to assure conformity to Workers’ Compensation Law, Division rules and procedures.

1. Resolves disputes to avoid litigation between injured workers, employers and attorneys. In addition, attend hearings and depositions when required.
2. Review Permanent Total files for annuity payments, joint petition and stipulation settlements, lump-sum advance payments, carrier election changeovers, unemployment compensation, social security benefits and Permanent Total closed cases.
3. Verifies proper receipt of supplemental payments through listing of checks held, initial supplemental payments, signature comparisons, address changes and other documents.
4. Reviews vital statistics reports social security advisories, carrier reports, Notice of Action/Change (DWC-4’s) and correspondence in order to timely terminate benefits to ineligible claimants.
5. Prepare summary reports of opinions and recommendations submitted by Division staff and other consultants.
6. Investigates final orders of Deputy Commissioners, District Court of Appeals and State Supreme Court and takes action to assure employer/carriers compliance with the Order and/or refer to Office of the General Counsel for clarification and opinion.

Conducts on-site field audits, desk audits, and re-audits of insurers to ensure proper carrier practices relating to workers’ compensation claims handling procedures. The Workers’ Compensation Specialist confers with company personnel and officials regarding practices or possible violations of the Workers’ Compensation Law and determines penalties as required. The Workers’ Compensation Specialist audits information obtained from thorough examination of Division and company field office case files and compiles statistical data to determine compliance with Division rules. Upon completion of an audit, a formal report is compiled producing audit findings for distribution to appropriate parties. The Workers’ Compensation Specialist is responsible, if applicable, for recommendation of revocation and/or suspension of an insurer’s license to conduct business in the State of Florida.

Works closely with other agencies and within the Division in the following manner:

1. Coordinates with the Special Disability Trust Fund - Fiscal Section on payment and/or suspension of supplemental benefits, address changes and guardianship orders.
2. Corresponds with Social Security Administration on disability benefits information and dual social security number verifications.
3. Requests and utilizes rehabilitation evaluations and prepares background information on trial work referrals.
4. Prepares background information on P.T. cases requiring review by department attorneys and utilizes case law updates and legal advisory opinions in determining proper handling of cases.
5. Prepares background information on cases to be referred to the Bureau of Fraud.
6. Prepares background information on cases to be referred to the Department.
7. Review orders of Judges of Compensation Claims, First District Court of Appeals and Florida Supreme Court to determine proper handling of P.T. cases.

Monitors, examines, and inputs data in the Divisions’ data base system. Verifies for accuracy of information

Conducts training sessions 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.

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.