Workers' Compensation Claims Adjuster

This is a fully remote position, open to applicants in Florida.

📋 Description

• Conduct investigations on assigned Florida Workers’ Compensation claims.

• Assess claim details, encompassing Florida Statute and case law, to ascertain compensability and the overall value of the claim while establishing suitable reserves.

• Promptly provide benefits and initiate state filings while exercising discretion and independent judgment.

• Start investigations and appoint defense counsel when appropriate.

• Ensure accurate indemnity payments are made timely and maintain a diary for ongoing payments.

• Manage EDI filings and rejections in collaboration with the EDI adjuster.

• Oversee medical treatment alongside the assigned Nurse Case Manager.

• Review, document, and approve medical bills for payment within three days of receipt.

• Authorize necessary medical services as specified by Florida Statute 440.13.

• Evaluate if vocational rehabilitation services are required for an employee's return to work.

• Coordinate light duty options and reasonable accommodations with medical providers and employers.

• Maintain adequate reserves for the lifetime of the claim utilizing reserve worksheets, ODG Guidelines, Workers’ Computation software, and Davies Claims North America reserving philosophy.

• Attend client meetings as needed and maintain regular phone contact to ensure client satisfaction.

• Uphold diary and workflow requirements.

• Keep a working knowledge of FL Workers’ Compensation Statutes and Rules, along with their application.

• Direct defense counsel in the management of litigation claims.

• With input from defense, make prompt decisions regarding litigated issues.

• Safeguard Medicare’s interests in line with MMSEA Section 111 Reporting requirements.

• Examine claims for potential red flags.

• Show the ability to identify and pursue subrogation, contribution, indemnification, or other avenues to compel responsible third parties to share in the settlement burden.

• Request reimbursement at least quarterly and follow up for timely receipt from excess carrier(s).

• Comply with client profile instructions.

• Report any overall account or client concerns to the supervisor or upper management.

• Notify the QA Manager and Executive Vice President of any E&O concerns.

• Maintain a 97% claim closure ratio.

⛳️ Requirements

• 3-5 years of experience in handling Lost Time/Legal claims; 5+ years preferred.

• Hold a FL-All Lines Adjuster or Workers’ Compensation License and maintain CEU credits for the license.

• Previous experience in settling claims.

• Proficient in Microsoft Office Suite.

• Proactive, independent, and capable of taking initiative with consistent follow-through.

• Excellent verbal and written communication skills, conducted in a timely manner.

• Strong time management abilities with the capacity to work with and meet deadlines.

• Exceptional multitasking and prioritization skills, along with excellent organization and documentation capabilities in a fast-paced, dynamic environment.

• An excellent team player with strong interpersonal skills.

• High attention to detail and strong problem-solving skills.

• Able to work collaboratively and independently with minimal supervision.

• Demonstrate discretion with sensitive and confidential information.

🏝️ Benefits

• Medical, dental, and vision plans to support your health and that of your family.

• A 401(k) plan with employer matching.

• Time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees.

• Paid holidays.

• Life insurance and both short-term and long-term disability coverage.

• Paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.

• Diversity and inclusion initiatives.