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Davies · 2 months ago

Worker's Comp Lost Time Adjuster

Lakewood Ranch, FL

Full-time

Hybrid

Entry Level

$48K/yr - $55K/yr

1+ years exp

Davies is a specialist professional services and technology firm, actively driving innovation in the insurance sector. They are seeking an experienced Medical Only/Lost Time Adjuster to conduct thorough investigations of Workers’ Compensation claims, adjusting claims for TPA clients and ensuring timely state filings while exercising discretion and independent judgment.

Commercial InsuranceFinancial ServicesInsuranceInsurTech

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

Workers’ Compensation claimsFlorida All Lines Adjuster licenseWorkers’ Compensation Statutes knowledgeClaim closure ratioMulti-taskingDocumentation skillsProblem solving skillsOrganizational skills

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.

Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.

Paid holidays.

Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.