Davies North America · 1 week ago
Worker's Comp Lost Time Adjuster
Lakewood Ranch, FL
Full-time
Hybrid
Entry Level
$48K/yr - $55K/yr
1+ years expDavies North America is a leading company in the insurance and regulated sectors, focused on innovation and excellence. They are seeking an experienced Workers' Comp Lost Time Adjuster to conduct thorough investigations of Workers’ Compensation claims, adjust claims for TPA clients, and ensure compliance with state filings.
Financial ServicesInsurance
Responsibilities
Adjust claims for assigned Davies Claims North America TPA clients
Investigate claims by completing 24-hour contact with employee, employer, physician(s), and witnesses
Evaluate claim detail, Florida Statute, and case law to determine compensability and total value of claim
Display capability of setting and adjusting reserve amounts accordingly
Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments
Ensure timely and proper completion of all required State filings
Handle EDI filings and rejections in conjunction with EDI adjuster
Monitor medical treatment in conjunction with the 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
Maintain regular telephone contact with injured employees
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
Evaluate cases and negotiate settlements when appropriate, protecting Medicare’s interests
Review claims for possible red flags
Identify and pursue subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden
Make timely notice to the excess carrier in all cases while meeting reporting criteria and keeping the carrier updated on claim status
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 EVP
Attend claims meetings at client locations, client visits, seminars for obtaining CEU credits
Interact with Managers, Training Coordinator, Supervisors, Adjusters, Nurse Case Managers, Team Assistants, Employers, Injured Workers, Medical Providers, Ancillary Providers, State Employees, Insurance Carriers, Excess Carriers, and Brokers as needed
Convey 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
Qualification
Required
1 to 2 years handling Workers' Compensation claims
Possession of an active Florida All Lines Adjuster or Workers' Compensation license
Maintain required CEU credits for licensure
Maintain working knowledge of Workers' Compensation Statutes and Rules, and their application
Maintain diary and workflow requirements
Maintain 97% claim closure ratio
Benefits
Medical, dental, and vision plans to ensure your health and that of your family.
A 401k plan with employer matching to help you build a secure financial future.
Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees.
Paid holidays.
Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.
Company
Davies North America
We deliver professional services and technology solutions across the risk and insurance market, including claims, underwriting, distribution, regulation, customer experience, human capital, digital transformation and change management.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Anne Ingoldsby
Chief Operating Officer
Beverly Adkins
Chief Operating Officer
Company data provided by crunchbase