What are the responsibilities and job description for the Medical only adjuster position at Davies Group?
Workers’ Compensation Medical Only Adjuster
Our Story
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.
What’s in Store
We're on the lookout for a Workers’ Compensation Medical Only Adjuster to join our growing team! As a Workers’ Compensation Medical Only Adjuster, you will conduct thorough investigations of assigned workers’ compensation claims, provide benefits, and initiate State filings timely while exercising discretion and independent judgement.
You will need to have proven critical thinking skills that demonstrate analysis, judgement, sound decision making with focus on attention to details, great customer service skills, and excellent communication skills (both written and verbal).
- Investigate claims by interviewing claimant, employer, witnesses, and physicians
- Determine compensability and total value of claim
- Monitor medical treatment in conjunction with Medical Management personnel
- Promptly approve medical bills for payment
- Provide prompt authorization of medical services
- Coordinate light duty availability with medical providers and employers
- Maintain adequate reserves for life of claim
- Convey positive attitude and team spirit for optimum provision of services to customers
- Attend client meetings as necessary
- Determine subrogation potential and pursue recovery where applicable
- Maintain acceptable claim closure ratio
- Negotiate settlement of claim if warranted
- Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
- Perform other duties as assigned by the Claims Supervisor, Assistant Claims Manager, Training Coordinator, Claims Manager, or QA Manager
This role is a full-time, hybrid position based in the Lakewood Ranch, FL area.
Your Expertise, Skills, and Abilities
- Sustain working knowledge of workers’ compensation law, rules, procedures, case law, liability principles, and medical terminology and procedures
- Maintain diary and workflow processes
- Review of 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
- Must maintain claim closure of at least 97%
- Reporting of any overall account or client concerns to the supervisor or upper management
- Proficiency in Microsoft Word, Excel, and Outlook
- Other Skills and Abilities : Proactive, independent, and takes initiative with consistent follow throughSuperb communication skills, verbal and written, conducted in a timely mannerSuperior time management skills with capability of working with and meeting deadlinesExceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environmentExcellent team player with interpersonal skillsHigh level attention to detail and problem-solving skillsCapable of working collaboratively and independently with minimal supervisionExhibit discretion with sensitive and confidential informationDisplay a comfort level working with key people at all levels within an organization
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.
LI-HYBRID
LI-NP1
Last updated : 2024-11-19
