Workers' Compensation Excess/SDF Claims Specialist (Remote)

Davies•Home, WV

7d•$45,000 - $60,000•Remote

About The Position

Davies North America is seeking a Workers' Compensation Excess/SDF Claims Specialist to submit timely and appropriate excess reports to excess carriers on workers’ compensation claims, meeting contract timelines and financial thresholds. The role also pursues, perfects, and manages SDF claims through conclusion in accordance with company and state regulations. The specialist coordinates with clients and insurance agents to obtain excess policies and declaration pages, communicates with excess carriers, identifies retention levels and special reporting requirements, and prepares initial, supplemental, and final claim reports. The role works with claims specialists and supervisors on excess reporting and settlement authority, evaluates files for SDF potential, pursues fund reimbursement, and coordinates with employers, attorneys, field representatives, doctors, the SDTF, and the Florida Department of Financial Services. It also maintains file documentation and diaries, completes required reporting and forms, and provides periodic status reports to clients and carriers.

Requirements

1–2 years of claims-handling experience in Florida workers’ compensation law.
1–2 years of office experience.
Active Florida adjuster license (FL 5-24 or 5-20/6-20).
Working knowledge and experience handling workers’ compensation claims.
Knowledge of state-specific workers’ compensation statutes.
Ability to operate a personal computer and related claims and business software effectively.
Good oral and written communication skills and customer service skills.
Excellent organizational skills.
Team-player attitude.
Good attendance.

Responsibilities

Coordinate with clients and insurance agents to obtain excess insurance policies and declaration pages for each year with open claims and maintain them in master account files.
Notify each client’s excess carrier that the company has been retained to provide Third Party Administration services and explain its usual claim-reporting procedures.
Identify excess-policy retention levels and special reporting requirements to the appropriate claim supervisors, claims specialists, and IS Department.
Submit initial notices, follow-up or supplemental reports, and final reports to excess carriers within their required timelines, including supporting details and documentation.
Assist claims specialists in obtaining settlement authority from the appropriate excess carrier for claims expected to reach the Self-Insured Retention level, and provide settlement documentation with the final report.
Maintain communication with claims specialists and supervisors to ensure qualifying claims are reported professionally and promptly to excess carriers.
Evaluate files for SDF potential and pursue claims to meet state requirements for fund reimbursement.
Contact employers, attorneys, field representatives, and doctors in a timely manner.
Notify the SDTF of potential settlements on SDF cases and advise claims specialists about the Fund’s settlement-approval procedures.
Ensure consistent system documentation and timely compliance with state reporting requirements.
Maintain file diaries and keep files current according to company standards.
Correspond with excess carriers and the SDTF regarding excess and SDF issues.
Update SDF status reports for certain clients quarterly and excess status reports for excess carriers on specified accounts every 3, 6, or 12 months.
Submit initial and annual reimbursement requests to the SDTF.
Monitor diary, complete SI-19 forms, facilitate customer execution, and ensure timely filing with the Florida Department of Financial Services.
Perform other duties as assigned.
Maintain regular and dependable attendance and be available to perform responsibilities during established work hours.