Workers' Compensation Legal Adjuster
About Us
At Davies, we get it... you are not just looking for a job, you are looking to build a life and a career. We believe in our people and realize that our success is a direct result of creating a learning atmosphere, leadership opportunities, and promoting from within. We believe that engaging in corporate social activities and working together as a team is a vital part of the Davies culture.
With a multinational global team, Davies Group is a specialist professional services and technology firm working in partnership with leading insurance, highly regulated, and global businesses. At Davies Group, we help clients to manage risk, operate core business processes, and to transform and grow. We deliver operations, consulting and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation, customer experience, human capital, transformation, and change management.
Are you looking for a company that is Dynamic and Innovative where the employees are Connected and Succeed Together? If so, Davies may just be the right choice for you.
Job Overview
Davies Claims North America is looking for an experienced Workers Compensation Legal Adjuster to evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim then set and adjust reserve accordingly. Reporting to the Workers Compensation Claims Supervisor, you will investigate assigned workers compensation claims, provide benefits, and initiate state filings promptly while exercising discretion and independent judgement.
To be successful in this role, you need to possess excellent working knowledge of workers compensation laws, rules, procedures, case law, liability principles, and medical terminology. You must have at least 5 years of Workers Compensation experience, including experience with presumption claims, as well as settling claims, and be able to use Microsoft Office Suite and various other software programs. Additionally, you will need to be proactive and exhibit superior time management skills with the capability of working with and meeting deadlines as well as be willing to attend claims meetings at client locations, participate in client visits, attend seminars to maintain CEU credits and attend hearings, mediations, and depositions, as needed.
This role is a full-time, hybrid position based out of Lakewood Ranch, FL and may require travel at times.
Responsibilities and Duties
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 Workers Compensation Statute and Rules, and their application
Direct defense counsel in handling of litigation claims
With defense input, make timely decisions regarding litigated issues
Protect Medicares 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
Maintain required CEU credits
Convey a 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
Experience and Qualifications
Required
5+ years of Lost Time/Legal Adjusting claims experience, including presumption claims
Active FL All Lines Adjuster or Workers' Compensation License
Maintain CEU credits for FL All Lines Adjuster or Workers Compensation License
Previous experience settling claims
Experience with Microsoft Office Suite
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
Knowledge, Skills, and Abilities
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
Essential Requirements
Must have US work rights
Must speak English
5+ years of Lost Time/Legal Adjusting claims experience, including presumption claims
Active FL All Lines Adjuster or Workers' Compensation License
Maintain CEU credits for FL All Lines Adjuster or Workers Compensation License
Previous experience settling claims
Experience with Microsoft Office Suite
Other Duties
This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the individual for this job and is subject to change with or without notice.
Diversity and Inclusion
Davies is committed to being a diverse and inclusive workplace. We welcome candidates of all genders, gender identity and expression, neurodiversity, sexual orientation, disability, physical appearance, body size, race, age, nationality, and belief (or lack thereof).
Rewards and Recognition
We embrace innovation and run an annual competition available for all colleagues to submit their ideas. The top finalists travel to the current years competition site where they pitch their ideas to our investors. The winner receives funding to bring their idea to life and the runners up receive a reward for their involvement. Some of our teammates have moved across into brand new positions to further develop their ideas/projects!
Benefits
Medical, dental, and vision plans
401k plan with employer matching
Discretionary Time off (Vacation & Sick/Safety) and Paid Holidays
Life insurance, short term, and long-term disability plans
Amazing Executive and Senior leadership as well as fabulous teammates
Position Type, Work Environment and Physical Demands
This is a hybrid, full time, salaried, exempt position that predominantly operates remotely from a professional home-based environment and onsite from an office-based environment routinely using standard office equipment such as computers, phones, printers, photocopiers, and scanners and requires prolonged periods of sitting at a desk while working on a computer. While performing the duties of this job, the individual will be required to regularly hear and talk. This is a largely sedentary role requiring the ability to sit at a desk, reach outward, use a phone, have use of fingers to operate office equipment such as a keyboard, mouse, phone, printer, copier, and to reach above the head, bend, or stand, as necessary.
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