Davies North America

Global insurance professional services and tech

Workers' Compensation Lost Time Adjuster

Claims AdjudicationUpdated on Nov 13

Full-timeLakewood Ranch, FL, USA$55k - $58k /yr

About the Job

Requirements

At least 1 to 3 years of experience handling Workers’ Compensation claims.
Possession of an active Florida All Lines Adjuster or Workers’ Compensation license.
Maintain required continuing education credits for licensure.
Maintain working knowledge of Workers’ Compensation statutes and rules and their application.
Maintain diary and workflow requirements and a 97% claim closure ratio.
Demonstrate proactive and independent work with initiative and consistent follow-through.
Communicate effectively verbally and in writing, in a timely manner.
Manage time effectively, meet deadlines, and multitask and prioritize while maintaining organization and documentation in a fast-paced work environment.
Work collaboratively and independently with minimal supervision.
Exercise discretion with sensitive and confidential information.
Demonstrate attention to detail, problem-solving, and interpersonal skills.

Responsibilities

Adjust claims for assigned Davies Claims North America third-party administrator clients.
Investigate claims by completing 24-hour contact with employees, employers, physicians, and witnesses.
Evaluate claim details, Florida statutes, and case law to determine compensability and total claim value.
Set and adjust reserve amounts as appropriate, maintaining reserves throughout the life of each claim using reserve worksheets, ODG Guidelines, Workers’ Compensation software, and the company’s reserving philosophy.
Initiate accurate indemnity payments promptly and maintain diaries for ongoing payments.
Complete required state filings accurately and on time.
Handle EDI filings and rejections with the EDI adjuster.
Monitor medical treatment with the assigned Nurse Case Manager.
Review, document, and approve medical bills for payment within three days of receipt.
Authorize appropriate medical services under Florida Statute 440.13.
Maintain regular telephone contact with injured employees and clients to support client satisfaction.
Determine whether vocational rehabilitation services are needed to help employees return to work.
Coordinate light-duty availability and reasonable accommodations with medical providers and employers.
Attend client meetings as necessary and attend claims meetings at client locations, client visits, and seminars for continuing education credits.
Evaluate cases and negotiate settlements when appropriate while protecting Medicare’s interests.
Review claims for potential red flags.
Identify and pursue subrogation, contribution, indemnification, or other opportunities to require responsible third parties to bear their share of settlement costs.
Notify excess carriers promptly in all cases meeting reporting criteria, keep carriers updated on claim status, request reimbursement at least quarterly, and follow up for timely receipt.
Follow client profile instructions.
Report account or client concerns to the supervisor or upper management, and report errors-and-omissions concerns to the Quality Assurance Manager and Executive Vice President.
Interact as needed with managers, training coordinators, supervisors, adjusters, nurse case managers, team assistants, employers, injured workers, medical and ancillary providers, state employees, insurance and excess carriers, and brokers.
Perform other duties as assigned.

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.

Davies Claims North America is looking for an experienced Lost Time Adjuster to conduct thorough investigations of assigned Workers’ Compensation claims. Reporting to the Workers’ Compensation Supervisor, you will adjust claims for assigned Davies Claims North America TPA clients, provide benefits, and initiate state filings timely while exercising discretion and independent judgment. To be successful in this role, you need to be proactive and independent while taking initiative with consistent follow through, demonstrate a high level of attention to detail, and possess superb problem solving skills. You must have at least 1 to 3 years of experience handling Workers’ Compensation claims as well as exhibit working knowledge of Workers’ Compensation Statutes and Rules and their application. Additionally, you will need to display an exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment.

This is a full-time hybrid position requiring onsite attendance three days per week at our client's office in Palm Beach County, Florida, with the remaining two days worked remotely from a home office. Candidates must be comfortable with a consistent hybrid schedule and regular in-person collaboration at the client location.

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

1 to 3 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
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

About the Company

Davies North America

Global insurance professional services and tech

Davies North America is a global professional services and technology company that began in the UK as an insurance claims manager. It now provides technology, consulting, and legal solutions to clients in regulated industries, including insurance, through managed services, outsourcing, and advisory offerings. The company grows by acquiring other businesses to expand its geographic reach and service capabilities. Its goal is to become a global leader in professional services and technology for regulated industries, particularly in markets like the US, Canada, and Bermuda.

Company size: 5,001-10,000
Company stage: Debt Financing
Total funding: $363M
Headquarters: London, United Kingdom
Founded: 1968

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