Davies North America

Global insurance professional services and tech

Workers Compensation Lost Time Adjuster

Claims AdjudicationUpdated on Nov 13

Full-timeRemote in USA$68k - $74.8k /yr

About the Job

Requirements

Three to five years of Lost Time/Legal claims handling experience; five or more years is preferred.
Possess a Florida All Lines Adjuster or Workers’ Compensation license and maintain continuing education credits for the license.
Previous experience settling claims.
Experience with Microsoft Office Suite.
Demonstrate proactive, independent work with initiative and consistent follow-through.
Communicate verbally and in writing in a timely manner.
Manage time effectively and meet deadlines.
Multitask, prioritize, and maintain strong organization and documentation in a fast-paced, dynamic work environment.
Work collaboratively and independently with minimal supervision.
Exercise discretion with sensitive and confidential information.
Work comfortably with key people at all organizational levels.

Responsibilities

Investigate assigned Florida Workers’ Compensation claims and evaluate claim details, including Florida statutes and case law, to determine compensability and total claim value; set and adjust reserves accordingly.
Initiate investigations and assign defense counsel when appropriate.
Initiate accurate indemnity payments in a timely manner and maintain a diary for ongoing payments.
Complete 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.
Determine whether vocational rehabilitation services are needed to help an employee return to work.
Coordinate light-duty availability and reasonable accommodations with medical providers and employers.
Maintain adequate reserves for the life of each claim using 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 support client satisfaction.
Maintain diary and workflow requirements.
Maintain working knowledge of Florida Workers’ Compensation statutes and rules and their application.
Direct defense counsel in handling litigation claims and, with defense input, make timely decisions about litigated issues.
Protect Medicare’s interests under MMSEA Section 111 reporting requirements.
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.
Request reimbursement from excess carriers at least quarterly and follow up for timely receipt.
Adhere to client profile instructions.
Report overall account or client concerns to a supervisor or upper management.
Report errors-and-omissions concerns to the QA Manager and Executive Vice President.
Maintain a 97% claim closure ratio.

Desired Qualifications

A college degree.
Multiple years of experience handling several types of claims.
Presumption claims handling experience.
Experience with depositions, mediations, and litigation.
Experience with IDatix, reference books and periodicals, Workers Computation, ISO, and ShoreTel.

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.

What’s in Store
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.

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

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

Preferred:

College degree
Multiple years’ experience handling several types of claims
Presumption claims handling experience
Experience with depositions, mediations, and litigation
Experience with IDatix, Reference Books-Periodicals, Workers Computation, ISO, ShoreTel

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

Recently Posted Jobs

Explore more opportunities at Davies North America

See more jobs