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.
- What’s in Store We're on the lookout for a Workers’ Compensation Legal Adjuster to join our growing team in Florida!
- As a Workers’ Compensation Legal Adjuster, you will investigate assigned Florida Workers’ Compensation claims, evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim while setting appropriate reserves.
- You will also provide benefits and initiate state filings promptly while exercising discretion and independent judgement.
- 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 FL Workers’ Compensation Statutes 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