Worker's Comp Lost Time Adjuster

Worker's Comp Lost Time Adjuster

Imagine being part of a team that's not just shaping the future but actively driving it. At Davies North America, we're at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

Davies Claims North America is looking for an experienced Medical Only / Lost Time Adjuster to conduct thorough investigations of assigned Workers' Compensation claims. Reporting to the Workers' Compensation Supervisor, you will adjust claims for assigned Davies Claims North America TPA clients, provide benefits, and initiate state filings timely while exercising discretion and independent judgment. To be successful in this role, you need to be proactive and independent while taking initiative with consistent follow through, demonstrate a high level of attention to detail, and possess superb problem solving skills. You must have at least 1 to 2 years of experience handling Workers' Compensation claims as well as exhibit working knowledge of Workers' Compensation Statutes and Rules and their application. Additionally, you will need to display an exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment. This role is a full-time, hybrid position based in Lakewood Ranch, FL. There may be opportunities for remote work for extremely qualified individuals who do not reside in the geographical area.

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 2 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

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.

Diversity and Inclusion

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard. Compensation Transparency : The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.

About Davies

We are a specialist professional services and technology firm, working in partnership with leading insurance, highly regulated and global businesses. We help our clients to manage risk, operate their core business processes, transform and grow. We deliver professional services and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation & risk, customer experience, human capital, digital transformation & change management. Our global team of more than 8,000 professionals operate across ten countries, including the UK & the U.S. Over the past ten years Davies has grown its annual revenues more than 20-fold, investing heavily in research & development, innovation & automation, colleague development, and client service. Today the group serves more than 1,500 insurance, financial services, public sector, and other highly regulated clients.