Workers Compensation Lost Time Adjuster (Remote)

Davies • Home, WV

6d • $68,000 - $74,800 • Remote

About The Position

Davies North America is seeking a Workers’ Compensation Legal Adjuster to investigate and manage assigned Florida workers’ compensation claims. The role evaluates claim details, including applicable Florida statutes and case law, to determine compensability and claim value, set reserves, provide benefits, and make timely state filings while exercising discretion and independent judgment. The position also works with defense counsel, nurse case managers, clients, medical providers, employers, and excess carriers to manage claims and support appropriate outcomes.

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, initiative, and consistent follow-through.
• Strong verbal and written communication skills, delivered in a timely manner.
• Strong time-management skills and ability to meet deadlines.
• Ability to multitask, prioritize, organize, and document effectively in a fast-paced, dynamic work environment.
• Teamwork and interpersonal skills.
• Attention to detail and problem-solving skills.
• Ability to work collaboratively and independently with minimal supervision.
• Discretion in 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 claim value, and set and adjust reserves.
• Initiate investigations and assign defense counsel when appropriate.
• Initiate accurate, timely indemnity payments 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 in accordance with 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 throughout the life of each claim using 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 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.
• Make timely decisions regarding litigated issues with input from defense counsel.
• 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 hold responsible third parties accountable for their share of the settlement burden.
• Request reimbursement from excess carriers at least quarterly and follow up for timely receipt.
• Adhere to client profile instructions.
• Report account or client concerns to the supervisor or upper management.
• Report E&O 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 job 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.
• Paid sick leave, paid family and parental leave, and other mandated benefits where required by law.

What This Job Offers

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