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

Lost Time Adjuster handling Workers’ Compensation claims for Davies North America

Workers' Compensation Lost Time Adjuster

Lost Time Adjuster conducting investigations on Workers’ Compensation claims for Davies North America. Requires 1-3 years of relevant experience and state licensing.

• Manage moderate to complex workers’ compensation claims from initial investigation through resolution
• Conduct interviews with insured parties, claimants, witnesses, and other relevant individuals to assess claim eligibility
• Obtain statements; analyze coverage; determine compensability and applicable benefits; set appropriate reserves
• Negotiate settlements; and litigation management
• Handle a broad range of claims with settlement authority up to $175,000
• Provide mentorship or support to junior team members in their claims handling
• Maintain timely and accurate claim file documentation in accordance with company protocols
• Coordinate medical management, including UR/IMR and return-to-work strategies
• Participate in claim reviews and case discussions

Senior Workers’ Compensation Adjuster managing complex claims remotely

Senior Workers' Compensation Adjuster

Senior Workers’ Compensation Adjuster managing moderate to complex claims including investigation, negotiation, and litigation remotely. Seeking candidate with 5+ years California claims experience.

Workers Compensation Adjuster jobs in United States

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Workers' Compensation Lost Time Adjuster

Senior Workers' Compensation Adjuster