Workers Compensation Legal Claim Adjuster

Workers Compensation Legal Claim Adjuster

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Baylie Kull

Compensation: $75,000 - $85,000 / year

Description Our Story Imagine being part of a team that's not just shaping the future but actively driving it. At Davies North America, we're at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

We're on the lookout for a Workers' Compensation Legal Adjuster to join our growing team in Florida As a Workers' Compensation Legal 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. You will also 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
• 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 

Skills, knowledge & expertise

• 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 Benefits At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:

• 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.

  Diversity and Inclusion Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.

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