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Claims Specialist

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Claims Specialist

Salary

$67,119.92 - $100,680.42 Annually

Location

Employment Services, FL

Job Type

Full Time Regular

Job Number

2348-04

Department

Risk Management and Purchasing

Division

Risk Management and Purchasing 0400000000

Opening Date

11/04/2025

Closing Date

Continuous

FLSA

Exempt

Bargaining Unit

NA

+ Description

+ Benefits

+ Questions

GENERAL DESCRIPTION OF CLASS

This is a professional and responsible administrative position with the primary responsibility of effectively managing the City's workers' compensation, general liability, auto liability, and property claims. This classification is responsible for liaising with city employees, supervisors, and managers. This position also coordinates with legal representatives, insurance companies, medical and rehabilitation facilities/staff/and/or physicians. Furthermore, this individual is responsible for managing the filing of workers' compensation, general liability, and auto liability claims, as well as working with a contracted third-party administrator that processes the City's self-insured risk claims. This position interconnects daily with adjusters on matters related to healthcare, including approved providers, pharmacy charges, and the review and request of medical records and reports. This position supervises the work of two Risk Management Assistants. The incumbent has wide latitude for independent action and discretion in performing assigned duties and is normally expected to complete all functions with general direction. General direction is received from the Risk & Purchasing Director and the Risk Manager. Work is reviewed through conferences, reports, and results.

Please note this posting is "Continuous" and can close at ANY TIME WITHOUT NOTICE.

ESSENTIAL FUNCTIONS

+ Reviews and evaluates all new claims regarding settlement or denial and presents to authorized decision makers.

+ Considers settlement negotiations with attorneys and insurance companies.

+ Supports and assists the Director in ensuring departmental compliance and supporting the City's strategic plan.

+ Manages response and preparation of legal defense materials and documentation produced for litigation.

+ Acts as liaison with employees, adjusters, and legal representatives during claims processing, negotiation, closure, and settlements.

+ Develops, analyzes, and presents complex claims reports.

+ Analyzes data on all losses to determine causes and recommends corrective actions to prevent future losses.

+ Reviews and prepares authorization approvals or schedules information for various insurance claim payments.

+ Tracks and reports claim trends and report key information critical to the operation to the Director, Risk Manager, and department.

+ Represents the City at claims-related depositions, mediations, hearings, and trials.

+ May be required to participate in and/or facilitate training to support departmental or City initiatives and requirements.

+ May be required to work alternate hours as necessary for the efficient operation of the department.

+ Position is designated as Mission Critical.

ADDITIONAL FUNCTIONS

+ Performs related work as required.

QUALIFICATIONS (EDUCATION, TRAINING AND EXPERIENCE)

+ Bachelor's Degree from an accredited four-year college or university.

+ Five years of progressively responsible claims experience in workers' compensation insurance and/or auto/property casualty insurance.

+ One year of leadership experience providing mentorship, direction, and guidance to staff, including assigning work and ensuring follow-up on tasks.

An equivalent combination of education, training, and experience that provides the necessary knowledge, skills, abilities, and other competencies necessary for success in the target position may be considered.

SPECIAL REQUIREMENTS

+ Must possess and maintain a valid driver's license.

+ Must possess and maintain a valid telephone number.

+ A Florida All Lines Adjuster License is preferred.

KNOWLEDGE, SKILLS, ABILITIES

KNOWLEDGE

+ Thorough knowledge of workers' compensation, property, and casualty insurance coverage, including the methods, techniques, practices, procedures, terminology, and laws related to the preparation, reporting, investigating, and general administration of a workers' compensation and casualty claim program.

+ Knowledge of reserve analysis, cost allocation, forecasting, and claims monitoring.

+ Knowledge of the principles and practices of indemnity, subrogation, and claims reserves

+ Knowledge of the principles and practices of leadership, motivation, team building, and conflict resolution.

+ Knowledge of the principles and practices of business correspondence and report writing.

+ Knowledge of pertinent local, state, and federal laws, rules, and regulations.

+ Knowledge of budgeting procedures and techniques.

+ Knowledge of the principles and practices of organizational analysis and management.

+ Knowledge of the principles and practices of supervision, training, and personnel management.

+ Knowledge of modern office procedures, computer software, and equipment applications.

+ Strong oral and written communication skills.

ABILITIES

+ Ability to coordinate with insurance representatives, attorneys, physicians, and claimants in satisfactorily resolving claims.

+ Ability to make necessary investigations regarding loss experiences and take the necessary action to ensure the exposure is reduced or eliminated.

+ This position requires integrity, confidentiality, sound judgment, and strong decision-making skills.

WORKING ENVIRONMENT/PHYSICAL REQUIREMENTS

+ The job requires sedentary work with occasional walking or standing, exerting up to 10 pounds of force regularly, and performing routine keyboard operations.

+ The job risks exposure to traffic and possible exposure to hazardous atmospheric conditions.

+ The job requires normal visual acuity, field of vision, hearing, speaking, color perception, sense of taste, sense of smell, depth perception, and texture perception.

All City of Lakeland positions are subject to testing (e.g. written, oral, performance, computerized, interview, and/or any combination). Candidates selected for testing will be notified via email or telephone. Please check your e-mail and telephone messages regularly, including "junk" folders. Test times and locations to be announced.

THE CITY OF LAKELAND IS AN EQUAL OPPORTUNITY/EQUAL ACCESS EMPLOYER AND A DRUG FREE WORKPLACE.

City of Lakeland

2024 Summary Sheet

Annual Leave

Annual leave is accumulated bi-weekly and based upon years of service as follows:

Annual leave may be taken as earned by employees hired after January 1, 1989. Employees hired prior to that date use annual leave within the calendar year following the year the leave is earned. All employees may carry over up to a maximum of twenty (20) days at the end of the calendar year. Regular part-time employees who work at least twenty (20) hours per week accrue annual leave at the rate of four (4) hours per month.*

Sick Leave

Sick rate is accrued biweekly based upon years of service and standard hour classification. Eligible for use as soon as earned. Regular part-time employees who work at least twenty (20) hours per week accrue sick leave at the rate of four (4) hours per month.

*NOTE: REGULAR employees with a working day other than eight (8) hours, please contact your supervisor regarding these policies.

Sick Leave Pool

Allows employees to receive sick leave benefits in cases involving catastrophic or long-term illnesses or injuries after all personal leave time has been depleted. Regular full-time employees contribute eight (8) hours and Regular part-time employees contribute four (4) hours on an annual basis. Employees must have completed one full year of service on or before December 31st of the calendar year enrollment; and have accumulated at least forty (40) hours of sick time (twenty (20) hours for Regular part-time employees). Participation in this program is voluntary.

For more information contact Amanda Kaiser at 834-8768

Family & Medical Leave

Federal legislation guarantees up to twelve (12) weeks per year off work under certain circumstances outlined in the policy manual. The employees must have been employed by the City for at least twelve (12) months and have at least 1,250 hours of service during the 12-month period before the requested leave. The City will continue its group life and health insurance for an employee on leave at the same level and under the same conditions that existed while the employee was working.

For more information contact Dawn Justice at 834-6038.

Pension Plan

Provision for retirement income requiring mandatory participation for full-time regular employees.

Defined Benefit Plan:

Plan C Employee 4.16%

Employer 15.66%

OR

Defined Contribution Plan:

Executives, New Hires aged 52 and older, and Fire/Police Recruits

Employee 8.5% or 11% per election upon hire

Employer 15.39%

Deferred Compensation 457 Plan:

A voluntary plan that is invested in mutual funds. The Employees' Pension Board performs the due diligence on the mutual funds. Employees may reallocate their account at any time.

Maximum contribution for 2025 is $23,500; employees age 50 or older can also add a "catch-up" amount of $7,500; employees age 60-63 can also add a "catch-up" amount of $11,250.

Additionally, a match of up to 5% of salary is offered by the City in Plan C.

Holidays

Twelve (12) holidays, includes one (1) personal floating holiday to be used at any time after three (3) months of employment and prior to the end of the calendar year.

Funeral Leave

Up to three (3) days off with pay due to death of an immediate family member (as defined in the policy manual). Up to four (4) hours off with pay may be obtained through supervisor approval to attend local funeral services of persons other than immediate family.

Jury/Witness Duty

Employees required to serve on jury duty will be relieved of responsibility for their regular work shift or portion thereof and receive full pay while serving. All fees received for such service may be retained by the employee. Employees subpoenaed to any civil or criminal court proceeding, which employee is not personally or monetarily interested, shall be paid as if engaged in regular work activities.

Military Leave

Allows for up to 240 hours in any one calendar year for annual military training without loss of pay or benefits for any employee in some type of reserve status for the United States Armed Forces. (see policy manual for additional information).

Maternity Leave

Refer to Family & Medical Leave for those employees who qualify. Others may take up to three (3) months leave of absence available upon approval of the Department Head. Employees may opt to utilize any combination of paid (sick or annual leave) or unpaid leave.

Leave of Absence Without Pay

Written requests are subject to approval by Department Head and City Manager or designee for less than ninety (90) days. Requests for more than ninety (90) days also require Civil Service Board approval for employees in a Civil Service classification.

Longevity Pay

Tuition Reimbursement

Program provides employees up to $2,500 per fiscal year (October 1 through September 30) for reimbursement of tuition of approved college, university, vocational, or correspondence classes upon completion with a grade of "C" or better in credit courses only. Full reimbursement is given for courses and fees, upon approval. The program does not include reimbursement for cost of books, supplies or other related expenses.

For more information, contact Melissa Yelnick at 834-6844.

Suggestion Awards

A program designed to provide a consistent and organized method for employees to submit and be rewarded for constructive ideas for improvement. Maximum award is $1000.

For additional information, contact Employee Engagement and Development at 834-6837.

Direct Deposit of Paycheck (refer to handout in new employee folder)

An account must be established with the institution of your choice prior to signing up for direct deposit.

Uniforms/Equipment

Uniforms issued at no cost to employees for those job classifications which require them. Equipment is issued to employees at either no cost or discounted cost depending upon job classification.

Parking

Free while at work.

Break Periods

Employees may be permitted two (2), fifteen (15) minute breaks during the workday. The time shall be at the discretion of the supervisor.

For Information on Health Insurance, Dental, Vision, and Life Insurance please contact Benefits at 834-6797.

For Information on Retirement Benefits, contact the Retirement Services Department at 834-8765 or 834-8797.

For Information on Firefighter and Police Officer Retirement Benefits, contact Foster & Foster at 239-333-4872.

01

Please indicate which type of valid driver's license you possess.

+ Florida driver's license

+ I have an out-of-state driver's license

+ I do not have a valid driver's license

02

Please indicate your highest level of education.

+ Less than a High School Diploma or GED

+ High School Diploma or GED

+ Some College - less than 30 credit hours

+ Some College - 30 credit hours, but less than 60 credit hours

+ Associate's Degree or 60 credit hours

+ 90 Credit Hours

+ Bachelor's Degree or 120 credit hours

+ Master's Degree

+ Doctorate Degree

03

Please indicate your years of experience in progressively responsible claims experience in workers' compensation insurance and/or auto/property casualty insurance.

+ No experience

+ Some experience, but less than 1 year

+ At least 1 year, but less than 3 years

+ At least 3 years, but less than 5 years

+ At least 5 years, but less than 11 years

+ At least 11 years, but less than 14 years

+ At least 14 years, but less than 17 years

+ 17 years or more

04

Please provide a narrative supporting your answer to the above question. Be sure to include specific job title(s), job duties, organization(s) and the dates where the work was performed. Note: The employers and dates of employment you list here must also be included in the "Work Experience" section of this job application.

05

Do you have one (1) year of leadership experience providing mentorship, direction, and guidance to staff, including assigning work and ensuring follow-up on tasks?

+ Yes

+ No

06

Please provide a narrative supporting your answer to the above question. Be sure to include specific job title(s), job duties, organization(s) and the dates where the work was performed. Note: The employers and dates of employment you list here must also be included in the "Work Experience" section of this job application.

07

Do you possess a Florida All Lines Adjuster license?

+ Yes

+ No

08

Please describe your experience working with PeopleSoft/Oracle. If none, type N/A.

09

By clicking "Yes" below, I understand that all relevant work experience MUST be entered in the "Work Experience" section on my application. In addition, all current City of Lakeland employees must list all previous City of Lakeland work experience in the "Work Experience" section of the application. Failure to complete the "Work Experience" section will disqualify you from the application process.

+ Yes

+ No

Required Question

Employer

City of Lakeland, Civil Service

Address

500 N Lake Parker Avenue Lakeland, Florida, 33801

Phone

(863)834-8790

Website

http://www.lakelandgov.net/employmentservices