Workers' Compensation Legal Adjuster Position

2 weeks ago

Bradenton, Florida, United States Davies Claims North America Full time
Job Description

About Davies Claims North America

We are a specialist professional services and technology firm working in partnership with leading insurance, highly regulated, and global businesses. Our team helps clients to manage risk, operate core business processes, and to transform and grow.

Job Overview

We are seeking an experienced Workers' Compensation Legal Adjuster to evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim then set and adjust reserves accordingly. The successful candidate will investigate assigned Workers' Compensation claims, provide benefits, and initiate state filings promptly while exercising discretion and independent judgement.

Responsibilities and Duties

  • Evaluate claim detail, including Florida Statutes and case law, to determine compensability and total value of the claim; set and adjust reserves accordingly
  • Initiate investigation and assign defense counsel when appropriate
  • Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments
  • Timely proper completion of state filings
  • Handle EDI filings and rejections in conjunction with EDI adjuster
  • Monitor medical treatment in conjunction with assigned Nurse Case Manager
  • Review, document, and approve medical bills for payment within three days of receipt
  • Authorize appropriate medical services as outlined per Florida Statute 440.13
  • Determine whether vocational rehabilitation services are needed for an employee to return to work
  • Coordinate light duty availability and reasonable accommodations with medical providers and employers
  • Maintain adequate reserves for life of claim utilizing reserve worksheets, ODG Guidelines, Workers' Computation software and Johns Eastern reserving philosophy
  • Attend client meetings as necessary, and maintain regular telephone contact to ensure client satisfaction
  • Maintain diary and workflow requirements
  • Maintain working knowledge of Workers' Compensation Statutes and Rules, and their application
  • Direct defense counsel in handling of litigation claims
  • With defense input, make timely decisions regarding litigated issues
  • Protect Medicare's interest in conjunction with MMSEA Section 111 Reporting requirements
  • Review claims for possible red flags
  • Demonstrate capability of identifying and pursuing subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden
  • Request reimbursement at least quarterly and follow up for timely receipt from excess carrier(s)
  • Adhere to client profile instructions
  • Report any overall account or client concerns to the supervisor or upper management
  • Report any E&O concerns to the QA Manager and Executive Vice President
  • Maintain 97% claim closure ratio
  • Maintain required CEU credits
  • Convey a positive attitude and team spirit for optimum provision of services to customers
  • Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
  • Perform other duties as assigned

Experience and Qualifications

Required

  • 5+ years of Lost Time/Legal Adjusting claims experience
  • Possess a FL All Lines Adjuster or Workers' Compensation License
  • Maintain CEU credits for FL All Lines Adjuster or Workers' Compensation License
  • Previous experience with settling claims
  • Experience with Microsoft Office Suite

Knowledge, Skills, and Abilities

  • Proactive, independent, and takes initiative with consistent follow through
  • Superb communication skills, verbal and written, conducted in a timely manner
  • Superior time management skills with capability of working with and meeting deadlines
  • Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment
  • Excellent team player with interpersonal skills
  • High level attention to detail and problem-solving skills
  • Capable of working collaboratively and independently with minimal supervision
  • Exhibit discretion with sensitive and confidential information
  • Display a comfort level working with key people at all levels within an organization

Essential Requirements

  • Must have US work rights
  • Must speak English
  • 5+ years of Lost Time/Legal Adjusting claims experience
  • Possess a FL All Lines Adjuster or Workers' Compensation License
  • Maintain CEU credits for FL All Lines Adjuster or Workers' Compensation License
  • Previous experience settling claims
  • Experience with Microsoft Office Suite

Benefits

  • Medical, dental, and vision plans
  • 401k plan with employer matching
  • Discretionary Time Off (Vacation and Safety/Sick Leave) and Paid Holidays
  • Life insurance, short term, and long-term disability plans
  • Amazing Executive and Senior leadership as well as fabulous teammates

Position Type, Work Environment and Physical Demands

This is a hybrid, full time, salaried, exempt position that predominantly operates from a professional home- and office-based environment routinely using standard office equipment such as computers, phones, printers, photocopiers, and scanners and requires prolonged periods of sitting at a desk while working on a computer. While performing the duties of this job, the individual will be required to regularly hear and talk. This is a largely sedentary role requiring the ability to sit at a desk, reach outward, use a phone, have use of fingers to operate office equipment such as a keyboard, mouse, phone, printer, copier, and to reach above the head, bend, or stand, as necessary.

Location

Davies Claims North America is currently able to support employees residing in the following US locations: Greater Sarasota, Florida area (Bradenton, Lakewood Ranch). If you live in—or are willing to relocate at your own expense to—any of the listed locations, we look forward to your application If there is a required or preferred location for an open role, it will be listed in the job description. Should your state not be listed, please visit https://davies-group.com/location/ to locate a subsidiary near you.

Diversity and Inclusion

Davies is committed to being a diverse and inclusive workplace. We welcome candidates of all genders, gender identity and expression, neurodiversity, sexual orientation, disability, physical appearance, body size, race, age, nationality, and belief (or lack thereof).

Rewards and Recognition

We embrace innovation and run an annual competition available for all colleagues to submit their ideas. The top finalists travel to the current year's competition site where they pitch their ideas to our investors. The winner receives funding to bring their idea to life and the runners up receive a reward for their involvement. Some of our teammates have moved across into brand new positions to further develop their ideas/projects

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