Workers' Compensation Medical Only/Lost Time Adjuster

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Lakewood Ranch, FL

Compensation: $47,000 - $52,000 / year

Description

Key Responsibilities

• Adjust claims for assigned Davies Claims North America TPA clients
• Investigate claims by completing 24-hour contact with employee, employer, physician(s), and witnesses
• Evaluate claim detail, Florida Statute, and case law to determine compensability and total value of claim
• Display capability of setting and adjusting reserve amounts accordingly
• Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments
• Ensure timely and proper completion of all required State filings
• Handle EDI filings and rejections in conjunction with 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 per Florida Statute 440.13
• Maintain regular telephone contact with injured employees
• Determine whether vocational rehabilitation services are needed for an employee to return to work
• Coordinate light duty availability and reasonable accommodations with medical providers and employers
• Maintain adequate reserves for life of claim utilizing 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 ensure client satisfaction
• Evaluate cases and negotiate settlements when appropriate, protecting Medicare’s interests
• Review claims for possible red flags
• Identify and pursue subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden
• Make timely notice to the excess carrier in all cases while meeting reporting criteria and keeping the carrier updated on claim status
• Request reimbursement at least quarterly and follow up for timely receipt from excess carrier(s)
• Adhere to client profile instructions
• Report any overall account or client concerns to the supervisor or upper management
• Report any E&O concerns to the QA Manager and EVP
• Attend claims meetings at client locations, client visits, seminars for obtaining CEU credits
• Interact with Managers, Training Coordinator, Supervisors, Adjusters, Nurse Case Managers, Team Assistants, Employers, Injured Workers, Medical Providers, Ancillary Providers, State Employees, Insurance Carriers, Excess Carriers, and Brokers as needed
• Convey positive attitude and team spirit for optimum provision of services to customers
• Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
• Perform other duties as assigned

Skills, knowledge & expertise

• 1 to 3 years handling Workers’ Compensation claims
• Possession of an active Florida All Lines Adjuster or Workers’ Compensation license
• Maintain required CEU credits for licensure
• Maintain working knowledge of Workers’ Compensation Statutes and Rules, and their application
• Maintain diary and workflow requirements
• Maintain 97% claim closure ratio

• College degree or equivalent work experience

• Proactive, independent, and takes initiative with consistent follow through
• Superb communication skills, verbal and written, conducted in a timely manner
• Superior time management skills with capability of working with and meeting deadlines
• Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment
• Excellent team player with interpersonal skills
• High level attention to detail and problem-solving skills
• Capable of working collaboratively and independently with minimal supervision
• Exhibit discretion with sensitive and confidential information
• Display a comfort level working with key people at all levels within an organization

Benefits

• Medical, dental, and vision plans to ensure your health and that of your family
• A 401k plan with employer matching to help you build a secure financial future
• Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment
• Paid holidays
• Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones