What are the responsibilities and job description for the Workers' Compensation Legal Adjuster position at Davies Group?
About Us
At Davies, we get it... you are not just looking for a job, you are looking to build a life and a career. We believe in our people and realize that our success is a direct result of creating a learning atmosphere, leadership opportunities, and promoting from within. We believe that engaging in corporate social activities and working together as a team is a vital part of the Davies culture.
With a multinational global team, Davies Group is a specialist professional services and technology firm working in partnership with leading insurance, highly regulated, and global businesses. At Davies Group, we help clients to manage risk, operate core business processes, and to transform and grow. We deliver operations, consulting and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation, customer experience, human capital, transformation, and change management.
Are you looking for a company that is Dynamic and Innovative where the employees are Connected and Succeed Together? If so, Davies may just be the right choice for you.
Job Overview
Davies Claims North America is looking for an experienced Workers’ Compensation Legal Adjuster to evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim then set and adjust reserve accordingly. Reporting to the Workers’ Compensation Claims Supervisor, you will investigate assigned Workers’ Compensation claims, provide benefits, and initiate state filings promptly while exercising discretion and independent judgement.
To be successful in this role, you need to possess excellent working knowledge of Workers’ Compensation laws, rules, procedures, case law, liability principles, and medical terminology. You must have at least 5 years of Workers’ Compensation experience, experience settling claims, and be able to use Microsoft Office Suite and various other software programs. Additionally, you will need to be proactive and exhibit superior time management skills with the capability of working with and meeting deadlines as well as be willing to attend claims meetings at client locations, participate in client visits, attend seminars to maintain CEU credits & / or attend hearings, mediations, and depositions, as needed.
This role is a full-time, remote position.
Responsibilities and Duties
- Evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim; set and adjust reserve accordingly
- Initiate investigation and assign defense counsel when appropriate
- Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments
- Timely proper completion of State filings
- Handle EDI filings and rejections in conjunction with EDI adjuster
- Monitor medical treatment in conjunction with 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
- 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
- Maintain diary and workflow requirements
- Maintain working knowledge of Workers’ Compensation Statute and Rules, and their application
- Direct defense counsel in handling of litigation claims
- With defense input, make timely decisions regarding litigated issues
- Protect Medicare’s interest in conjunction with MMSEA Section 111 Reporting requirements
- Review claims for possible red flags
- Demonstrate capability of identifying and pursuing subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden
- 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 Executive Vice President
- Maintain 97% claim closure ratio
- Maintain required CEU credits
- Convey a 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
Experience and Qualifications
Required
Preferred
Knowledge, Skills, and Abilities
Essential Requirements
Other Duties
This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the individual for this job and is subject to change with or without notice.
Diversity and Inclusion
Davies is committed to being a diverse and inclusive workplace. We welcome candidates of all genders, gender identity and expression, neurodiversity, sexual orientation, disability, physical appearance, body size, race, age, nationality, and belief (or lack thereof).
Rewards and Recognition
We embrace innovation and run an annual competition available for all colleagues to submit their ideas. The top finalists travel to the current year’s competition site where they pitch their ideas to our investors. The winner receives funding to bring their idea to life and the runners up receive a reward for their involvement. Some of our teammates have moved across into brand new positions to further develop their ideas / projects!
Benefits
Position Type, Work Environment and Physical Demands
This is a hybrid, full time, salaried, exempt position that predominantly operates from a professional office environment routinely using standard office equipment such as computers, phones, printers, photocopiers, and scanners and requires prolonged periods of sitting at a desk while working on a computer. While performing the duties of this job, the individual will be required to regularly hear and talk. This is a largely sedentary role requiring the ability to sit at a desk, reach outward, use a phone, have use of fingers to operate office equipment such as a keyboard, mouse, phone, printer, copier, and to reach above the head, bend, or stand, as necessary.
Location
Davies Claims North America is able to support employees residing in the following US locations : Florida
LI-REMOTE
LI-NP1
