Job Description

Our Story

Imagine being part of a team thats not just shaping the future but actively driving it. At Davies North America were 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.

Were on the lookout for a Senior Workers Compensation Adjuster to join our growing team in Florida! As a Senior Workers Compensation 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 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 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

Skills knowledge & expertise

• 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
• 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

Equal Employment Opportunity & Legal Notices

Benefits

At Davies North America we are dedicated to supporting the wellbeing and future of our qualifying employees. Our comprehensive benefits package includes:

• Medical dental and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Timeoff policies including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for nonexempt employees
• Paid holidays
• Life insurance and shortterm and longterm disability coverage

Benefit offerings eligibility and required employer contributions may vary based on role classification and applicable federal state and local laws including those tied to an employees primary work location.

Where required by law the Company provides paid sick leave paid family and parental leave and other mandated benefits in accordance with applicable state and local requirements.

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.

Compensation Transparency:
The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills experience qualifications and geographic location which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.

Background Check & Fair Chance Compliance

Any background check or review of criminal history if applicable to the role will be conducted only after a conditional offer of employment and in compliance with applicable federal state and local laws including fairchance hiring requirements.

Massachusetts Notice
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

We do not use sites like Facebook Craigslist or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal please email us at

Required Experience:

Senior IC

Job Tags

Full time, For contractors, Work at office, Local area

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