Workers' Compensation Claims Adjuster
3 weeks ago
At Davies Claims North America, we're looking for a skilled Workers' Compensation Claims Adjuster to join our team. As a key member of our claims department, you'll be responsible for evaluating claim details, determining compensability and total value of the claim, and setting and adjusting reserves accordingly.
This is a full-time, hybrid position based out of Lakewood Ranch, FL, with opportunities for career growth and professional development. If you have a strong understanding of workers' compensation laws, rules, and procedures, and excellent communication and problem-solving skills, we encourage you to apply.
Key Responsibilities:
- 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
- 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
Requirements:
- 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
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
Salary: $85,000 per year
Location: Lakewood Ranch, FL
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