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

About the role

Davies Claims North America is seeking an experienced Lost Time Adjuster to join our team. Reporting to the Workers’ Compensation Supervisor, this role involves conducting thorough investigations of assigned Workers’ Compensation claims, providing benefits, and initiating state filings.

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
• Maintain diary for ongoing payments and 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
• Cook up 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

Requirements

• At least 1 to 3 years of experience 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
• 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
• Display a comfort level working with key people at all levels within an organization

Skills, knowledge & expertise

• Handling Workers’ Compensation claims
• Active Florida All Lines Adjuster or Workers’ Compensation license
• Working knowledge of Workers’ Compensation Statutes and Rules, and their application
• Diary and workflow requirements
• 97% claim closure ratio
• Proactivity and independence
• Communication skills
• Time management skills
• Multi-tasking and prioritization
• Organization and documentation skills
• Teamwork and interpersonal skills
• Attention to detail and problem-solving skills
• Collaboration and independence
• Discretion with sensitive information
• Comfort level with key people

Benefits

Our comprehensive benefits package includes:

• Medical, dental, and vision plans
• 401(k) plan with employer matching
• Time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees
• Paid holidays
• Life insurance and short-term and long-term disability coverage
• Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location.

Pay

$55,000 - $58,000 / year

Schedule

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.