Medical Only/Lost Time Adjuster

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 Medical Only/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 role is a full time, home based position.

Responsibilities and Duties

• 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 Johns Eastern 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, Assistant Claims Manager, 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

Experience and Qualifications

Required

• Possess a FL All Lines Adjuster or Workers’ Compensation License
• 1 to 3 years handling Workers’ Compensation claims
• Maintain required CEU credits for licensure
• Maintain diary and workflow requirements
• Maintain 97% claim closure ratio
• Maintain working knowledge of Workers’ Compensation Statute and Rules, and their application

Preferred

• College degree or equivalent work experience 

Knowledge, Skills, and Abilities

• 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
• Exhibit discretion with sensitive and confidential information
• Display a comfort level working with key people at all levels within an organization

Essential Requirements

• Must have US work rights
• Must speak English
• Possess a FL All Lines Adjuster or Workers’ Compensation License
• 1 to 3 years handling Workers’ Compensation claims
• Maintain required CEU credits for licensure
• Maintain diary and workflow requirements
• Maintain 97% claim closure ratio
• Maintain working knowledge of Workers’ Compensation Statute and Rules, and their application

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

• Medical, dental, and vision plans
• 401k plan with employer matching
• Discretionary Time Off (Vacation and Sick Leave) and Paid Holidays
• Life insurance, short term, and long-term disability plans
• Amazing Executive and Senior leadership as well as fabulous teammates

Position Type, Work Environment and Physical Demands

This is a hybrid, full time, salaried, exempt position that predominantly operates remotely from a professional home or office-based 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 currently able to support employees residing in the following US locations: Florida. If you live in—or are willing to relocate at your own expense to—any of the listed locations, we look forward to your application! If there is a required or preferred location for an open role, it will be listed in the job description. Should your state not be listed, please visit https://davies-group.com/location/ to locate a subsidiary near you.

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