About this role
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. Davies North America , is looking for an experienced Workers’ Compensation Claims Specialist, responsible for the investigation, evaluation, disposition, and settlement of Workers’ Compensation claims for self-insured and public entity accounts, including complex and high exposure claims, with minimal supervision. This includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Requires independent decision making and a high level of discretion and judgment in claim handling functions on behalf of clients for claims service business operations, ensuring excellent customer relationships and quality customer service. Reporting to the WC Claims Supervisor, you will be responsible for the investigation, evaluation, disposition and settlement of Workers’ Compensation claims for self-insured and public entity accounts, including complex and high exposure claims, with minimal supervision. This includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Requires independent decision making and a high level of discretion and judgment in claim handling functions on behalf of clients for claims service business operations, ensuring excellent customer relationships and quality customer service. To be successful in this role, you need to have experience in a claims environment handling lost time claims, including litigated files. Remote Work: This role is remote, with the expectation of attending an in-person team meeting at the client's Orlando office one day per month (typically the second Wednesday of each month). Candidates must be able to travel to Orlando for these meetings. Build and maintain rapport with client contacts to ensure retention; perform in manner to meet/exceed client expectations, following policy and procedure per client. Manage and direct the claim file including determination of indemnity, calculate loss of income; whether medical is related and appropriate; evaluate treatment plan, testing, surgery, surveillance, attorney involvement, return-to-work, light duty; appropriate calculation and timely payment of all benefits. Handle legal aspects of the file in negotiation of settlement; develop litigation/defense strategies with attorneys assigned to the claim file. Handle depositions, mediations, and hearings. Maintain system diary, keeping all files current according to company standards and State timeframes, ensuring no late payments or fines. Evaluate files for reserve potential and for settlement (effective knowledge of MSAs and structured annuities). Handle claims consistent with client, state and company policy and procedure, and in accordance with any statutory, regulatory and ethics requirements. Document and communicate all claim activity timely and effectively and in a manner which supports the outcome of the claim file; develop and maintain a progressive plan of action. Follow protocol for file management including proper case note documentation, email/fax handling, naming imaged documents appropriately, updating required system fields and templates as required. Interact extensively with various parties involved in the claim process. Manage EDI requirements per state and company protocol in a timely and appropriate manner. Identify and pursue SDF, subrogation, fraud, vocational/field case management involvement, as necessary. Comply with excess carriers’ limits and reporting requirements. Properly handle status reports/claim reviews with clients; travel as required. Maintain current knowledge of law and statute, maintain CEUs and license in current status related to state in which handling claims.