Workers Compensation Lost Time Adjuster (Remote)

Davies • Home, AL

3d • Remote

About The Position

Davies North America is seeking a Workers’ Compensation Legal Adjuster to join its growing team handling Florida workers’ compensation claims. The adjuster investigates assigned claims and evaluates claim details, including applicable Florida statutes and case law, to determine compensability and claim value and to establish appropriate reserves. The role provides benefits and initiates state filings promptly while exercising discretion and independent judgment.

The adjuster manages claims through their lifecycle, including investigations, payments, medical care, litigation, reporting, client communication, and claim closure. They work with defense counsel, nurse case managers, employers, medical providers, clients, and excess carriers; comply with Florida workers’ compensation requirements; identify recovery opportunities; and follow client instructions and internal quality and reporting processes.

Requirements

• 3–5 years of lost-time or legal claims-handling experience; 5+ years preferred.
• Florida All Lines Adjuster or Workers’ Compensation license and maintenance of required continuing education credits.
• Previous experience settling claims.
• Experience with Microsoft Office Suite.
• Proactive, independent approach with initiative and consistent follow-through.
• Excellent verbal and written communication skills, conducted in a timely manner.
• Strong time-management skills and ability to meet deadlines.
• Ability to multitask and prioritize, with excellent organization and documentation skills in a fast-paced, dynamic work environment.
• Strong interpersonal skills and ability to work as a team player.
• High attention to detail and problem-solving skills.
• Ability to work collaboratively and independently with minimal supervision.
• Discretion when handling sensitive and confidential information.
• Comfort working with key people at all levels within an organization.

Nice To Haves

• College degree.
• Multiple years of experience handling several types of claims.
• Presumption claims-handling experience.
• Experience with depositions, mediations, and litigation.
• Experience with IDatix, Reference Books-Periodicals, Workers Computation, ISO, and ShoreTel.

Responsibilities

• Evaluate claim details, including Florida statutes and case law, to determine compensability and total claim value; set and adjust reserves accordingly.
• Initiate investigations and assign defense counsel when appropriate.
• Initiate accurate indemnity payments in a timely manner and maintain a diary for ongoing payments.
• Complete state filings properly and on time.
• Handle EDI filings and rejections in conjunction with the 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 in Florida Statute 440.13.
• Determine whether vocational rehabilitation services are needed to help an employee return to work.
• Coordinate light-duty availability and reasonable accommodations with medical providers and employers.
• Maintain adequate reserves over the life of each claim, using reserve worksheets, ODG Guidelines, Workers’ Computation software, and Davies Claims North America’s reserving philosophy.
• Attend client meetings as necessary and maintain regular telephone contact to support client satisfaction.
• Maintain diary and workflow requirements.
• Maintain working knowledge of Florida workers’ compensation statutes and rules and their application.
• Direct defense counsel in handling litigation claims and, with defense input, make timely decisions regarding litigated issues.
• Protect Medicare’s interests in conjunction with MMSEA Section 111 reporting requirements.
• Review claims for possible red flags.
• Identify and pursue subrogation, contribution, indemnification, or other opportunities to have responsible third parties bear their share of settlement costs.
• Request reimbursement at least quarterly and follow up to ensure timely receipt from excess carriers.
• Adhere to client profile instructions.
• Report account or client concerns to a supervisor or upper management.
• Report errors-and-omissions concerns to the QA Manager and Executive Vice President.
• Maintain a 97% claim closure ratio.
• Maintain regular and dependable attendance and be available to perform responsibilities during established work hours.

Benefits

• Medical, dental, and vision plans.
• 401(k) plan with employer matching.
• Discretionary Time Off for exempt employees and Paid Time Off for non-exempt employees.
• Paid holidays.
• Life insurance.
• Short-term and long-term disability coverage.
• Where required by law, paid sick leave, paid family and parental leave, and other mandated benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed