• Investigate and evaluate Florida workers’ compensation claims to determine compensability, exposure, and total claim value in accordance with Florida statutes and case law. • Establish and maintain appropriate reserves using reserving tools, ODG guidelines, and company reserving philosophy. • Initiate and manage indemnity payments and maintain diary systems for ongoing payments and claim activity. • Complete state-required filings and EDI reporting accurately and within required timelines. • Assign and coordinate with defense counsel on litigated claims and assist with litigation strategy. • Collaborate with Nurse Case Managers to monitor medical treatment and authorize appropriate medical services under Florida Statute 440.13. • Review and approve medical bills within required timeframes. • Determine need for vocational rehabilitation services to assist injured employees with return-to-work planning. • Coordinate light duty opportunities and workplace accommodations with employers and medical providers. • Maintain consistent communication with clients and attend client meetings as required. • Maintain accurate documentation, diaries, and workflow management to ensure regulatory compliance. • Identify potential subrogation or recovery opportunities and pursue appropriate reimbursement from responsible parties. • Protect Medicare’s interests and ensure compliance with MMSEA Section 111 reporting requirements. • Monitor claims for red flags or potential fraud indicators. • Request reimbursement from excess carriers as required and follow up on outstanding recoveries. • Escalate client concerns or E&O risks to leadership when appropriate. • Maintain performance expectations, including a 97% claim closure ratio.