Workers' Lost Time Adjuster - West Palm , FL

Workers' Compensation Lost Time Adjuster
- West Palm Beach, FL

Department: Claims Administration & Adjusting

Employment Type: Permanent
- Full Time

Location: Lakewood Ranch, FL

Reporting To: Alanna Ryder

Compensation: $55,000 - $58,000 / year

Davies Claims North America is looking for an experienced 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 3 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 is a full-time hybrid position requiring onsite attendance three days per week at our client's office in Palm Beach County, Florida, with the remaining two days worked remotely from a home office. Candidates must be comfortable with a consistent hybrid schedule and regular in-person collaboration at the client location.

• 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…