[Hiring] Workers' Compensation Claims Adjuster @Davies

Role Description

We're on the lookout for a Workers’ Compensation Claims Adjuster to join our growing team in Florida! As a Workers’ Compensation Claims Adjuster, you will:

• Investigate assigned Florida Workers’ Compensation claims.
• Evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim while setting appropriate reserves.
• Provide benefits and initiate state filings promptly while exercising discretion and independent judgement.

Key Responsibilities

• Evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim; set and adjust reserve 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 Davies Claims North America 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 FL 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.

Qualifications

• 3-5 years of Lost Time/Legal claims handling experience; preferred 5+ years.
• Possess FL-All Lines Adjuster or Workers’ Compensation License and maintain CEU credits for license.
• Previous experience with settling claims.
• Experience with Microsoft Office Suite.
• 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.

Benefits

• Medical, dental, and vision plans to support your health and that of your family.
• A 401(k) plan with employer matching.
• Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees.
• Paid holidays.
• Life insurance and short‑term and long‑term disability coverage.
• Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location.
• Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.