Workers’ Compensation Legal Adjuster - Florida Claims

We're on the lookout for a Workers’ Compensation Legal Adjuster to join our growing team specializing in Florida Claims!

As a Workers’ Compensation Legal Adjuster, you will investigate assigned Florida Workers’ Compensation claims, evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim while setting appropriate reserves. You will also provide benefits and initiate state filings promptly while exercising discretion and independent judgement.

Responsibilities and duties of this position include:

• Evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim; set and adjust reserve accordingly
• Initiate investigation and assign defense counsel when appropriate
• Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments
• Timely proper completion of State filings
• Handle EDI filings and rejections in conjunction with EDI adjuster
• Monitor medical treatment in conjunction with assigned Nurse Case Manager
• Review, document, and approve medical bills for payment within three days of receipt
• 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
• Attend client meetings as necessary, and maintain regular telephone contact to ensure client satisfaction
• Direct defense counsel in handling of litigation claims
• With defense input, make timely decisions regarding litigated issues
• Review claims for possible red flags
• Demonstrate capability of identifying and pursuing subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden

Your Expertise, Skills, and Abilities

• 3-5 years of Lost Time/Legal claims handling experience; preferred 5 years
• Possess Florida Adjuster or Workers’ Compensation License and maintain CEU credits for license
• Previous experience with settling claims
• Experience with Microsoft Office Suite
• 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

Preferred:

• College degree
• Multiple years’ 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, ShoreTel

Benefits

At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:

• 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