Workers' Compensation Claims Adjuster

MDD Forensic Accountants

Workers’ Compensation Claims Adjuster investigating Florida Workers’ Compensation claims and evaluating case details for compensability. Initiating benefits and managing claims processes effectively.

Posted 5/11/2026full-timeRemote • Florida • 🇺🇸 United StatesMid-LevelSenior💰 $80,000 - $85,000 per yearWebsite

About the role

Key responsibilities & impact

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
Provide benefits and initiate state filings promptly while exercising discretion and independent judgement
Initiate investigation and assign defense counsel when appropriate
Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments
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

Requirements

What you’ll need

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

Benefits

Comp & perks

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 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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims handlingindemnity paymentsmedical bill reviewvocational rehabilitationsubrogationsettling claimsreserve worksheetsWorkers’ Computation softwareEDI filingsFlorida Statute 440.13

Soft Skills

communication skillstime managementmulti-taskingorganization skillsproblem-solving skillsattention to detailinitiativeteam playerdiscretionindependent judgment

Certifications

FL-All Lines Adjuster LicenseWorkers’ Compensation License