Workers Compensation Adjuster

• Adjust claims for assigned Davies Claims North America TPA clients
• Investigate claims by completing 24-hour contact with employee, employer, physician(s), and witnesses
• Evaluate claim detail, Florida Statute, and case law to determine compensability and total value of claim
• Display capability of setting and adjusting reserve amounts accordingly
• Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments
• Ensure timely and proper completion of all required State filings
• Handle EDI filings and rejections in conjunction with EDI adjuster
• Monitor medical treatment in conjunction with the 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
• Maintain regular telephone contact with injured employees
• 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
• Evaluate cases and negotiate settlements when appropriate, protecting Medicare’s interests
• Review claims for possible red flags
• Identify and pursue subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden
• Make timely notice to the excess carrier in all cases while meeting reporting criteria and keeping the carrier updated on claim status
• 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 EVP
• Attend claims meetings at client locations, client visits, seminars for obtaining CEU credits
• Interact with Managers, Training Coordinator, Supervisors, Adjusters, Nurse Case Managers, Team Assistants, Employers, Injured Workers, Medical Providers, Ancillary Providers, State Employees, Insurance Carriers, Excess Carriers, and Brokers as needed
• Convey 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

Workers Compensation Adjuster jobs in Florida

See all jobs on JobTailor

Workers' Compensation Lost Time Adjuster