Davies North America is a leading company in the insurance and regulated sectors, focused on innovation and excellence. They are seeking an experienced Workers' Comp Lost Time Adjuster to conduct thorough investigations of Workers’ Compensation claims, adjust claims for TPA clients, and ensure compliance with 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
- 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
- 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
- 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.
- Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees.
- Paid holidays.
- Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.
Company Overview
We deliver professional services and technology solutions across the risk and insurance market, including claims, underwriting, distribution, regulation, customer experience, human capital, digital transformation and change management. It was founded in 1984, and is headquartered in San Antonio, Texas, USA, with a workforce of 5001-10000 employees. Its website is http://iasclaims.com.
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