Lost Time Workers Compensation Claims Adjuster

Davies•Home, AL

4d•Remote

About The Position

Davies North America is seeking an experienced Workers’ Compensation Claims Specialist to manage lost time claims for self-insured and public entity accounts. This role involves investigating, evaluating, and settling claims, including complex and high-exposure cases, with minimal supervision. The specialist will determine coverage, liability, and damages, set appropriate reserves, and make independent decisions with a high degree of discretion. The position requires excellent customer service and relationship management. Reporting to the WC Claims Supervisor, the role is crucial for claims service business operations, ensuring client satisfaction and adherence to policy and procedure.

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 and meet/exceed client expectations.
Manage and direct claim files, including determining indemnity, calculating loss of income, and assessing medical relation and appropriateness.
Evaluate treatment plans, testing, surveillance, attorney involvement, and return-to-work/light duty options.
Calculate and ensure timely payment of all benefits.
Handle legal aspects of files, negotiate settlements, and develop litigation/defense strategies with attorneys.
Conduct depositions, mediations, and hearings.
Maintain system diaries and keep files current according to company standards and state timeframes, avoiding late payments or fines.
Evaluate files for reserve potential and settlement, including knowledge of MSAs and structured annuities.
Handle claims consistent with client, state, and company policy and procedure, adhering to statutory, regulatory, and ethics requirements.
Document and communicate all claim activity timely and effectively, developing and maintaining a progressive plan of action.
Follow protocol for file management, including case note documentation, email/fax handling, document naming, and updating system fields/templates.
Interact extensively with various parties involved in the claim process.
Manage EDI requirements per state and company protocol.
Identify and pursue SDF, subrogation, fraud, and vocational/field case management involvement as necessary.
Comply with excess carriers’ limits and reporting requirements.
Properly handle status reports and claim reviews with clients.
Travel as required.
Maintain current knowledge of law and statute, and maintain CEUs and license in current status for the states in which claims are handled.