Lost Time Workers Compensation Claims Adjuster

Davies • Home, WV

5d • $70,000 - $80,000 • Remote

About The Position

Davies North America is seeking an experienced Workers’ Compensation Claims Specialist to handle the investigation, evaluation, disposition, and settlement of Workers’ Compensation claims for self-insured and public entity accounts. This role will manage complex and high exposure claims with minimal supervision, including determining coverage, liability, and damages, and setting appropriate reserves. The position requires independent decision-making and a high level of discretion in claim handling to ensure excellent customer relationships and quality service. The Claims Specialist will report to the WC Claims Supervisor and must have experience handling lost time claims, including litigated files.

Requirements

• Active Adjuster license (FL 5-24, 5-20 or 6-20).
• A minimum of three years of Florida claims-related experience with a consistent high level of performance and achievement.
• Extensive knowledge of accepted industry standards and practices including case law.
• Ability to successfully negotiate the settlement and disposition of claims, including the ability to interpret related documentation.
• Maintain knowledge of current trends, standards and law changes.
• Ability to effectively operate a personal computer and related claims and business software. Technically competent with systems.
• Must be self-directed and able to work independently.
• Ability to effectively present status updates in claims meetings with clients, etc.
• Good communication skills, both oral and written; good customer service skills.
• Assertive self-starter with excellent organizational skills. Team player. Good attendance.

Nice To Haves

• A four-year college degree or equivalent work experience is preferred.
• Familiarity with “paperless” work environment helpful.

Responsibilities

• Build and maintain rapport with client contacts to ensure retention; perform in a manner to meet/exceed client expectations, following policy and procedure per client.
• Manage and direct the claim file including determination of indemnity, calculate loss of income; whether medical is related and appropriate; evaluate treatment plan, testing, surgery, surveillance, attorney involvement, return-to-work, light duty; appropriate calculation and timely payment of all benefits.
• Handle legal aspects of the file in negotiation of settlement; develop litigation/defense strategies with attorneys assigned to the claim file. Handle depositions, mediations, and hearings.
• Maintain system diary, keeping all files current according to company standards and State timeframes, ensuring no late payments or fines.
• Evaluate files for reserve potential and for settlement (effective knowledge of MSAs and structured annuities).
• Handle claims consistent with client, state and company policy and procedure, and in accordance with any statutory, regulatory and ethics requirements.
• Document and communicate all claim activity timely and effectively and in a manner which supports the outcome of the claim file; develop and maintain a progressive plan of action.
• Follow protocol for file management including proper case note documentation, email/fax handling, naming imaged documents appropriately, updating required system fields and templates as required.
• Interact extensively with various parties involved in the claim process.
• Manage EDI requirements per state and company protocol in a timely and appropriate manner.
• Identify and pursue SDF, subrogation, fraud, vocational/field case management involvement, as necessary.
• Comply with excess carriers’ limits and reporting requirements.
• Properly handle status reports/claim reviews with clients; travel as required.
• Maintain current knowledge of law and statute, maintain CEUs and license in current status related to state in which handling claims.

Benefits

• Medical, dental, and vision plans
• A 401(k) plan with employer matching
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree