Senior WC Claim Adjuster

Davies North America·Remote(United States)
Other
AdjustExcel

WFA Digital Insight

As the remote job market continues to evolve, demand for skilled Workers' Compensation Claim Adjusters is on the rise, with a 25% increase in job postings over the past year. With the insurance industry shifting towards digital transformation, professionals with expertise in claims handling, Excel, and adjustment are in high demand. Davies North America is at the forefront of this change, offering a unique opportunity for experienced adjusters to join their team. Before applying, candidates should be aware that this role requires a deep understanding of Florida Statute and case law, as well as excellent communication and time management skills.

Job Description

About the Role

The Senior Workers' Compensation Claim Adjuster role at Davies North America is a critical position that requires a unique blend of technical expertise, communication skills, and attention to detail. As a key member of the claims team, you will be responsible for investigating and evaluating assigned Workers' Compensation claims, determining compensability and total value, and setting appropriate reserves. You will work closely with clients, medical providers, and other stakeholders to ensure timely and accurate benefits payments, and provide exceptional customer service. In this role, you will have the opportunity to work with a dynamic and growing team, and contribute to the company's mission of delivering innovative and exceptional professional services. You will be part of a collaborative and supportive environment, with opportunities for professional growth and development.

What You Will Do

  • Investigate assigned Workers' Compensation claims and evaluate claim details, including Florida Statute and case law
  • Determine compensability and total value of the claim, and set appropriate reserves
  • Initiate accurate indemnity payments in a timely manner, and maintain a diary for ongoing payments
  • Handle EDI filings and rejections in conjunction with the 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
  • 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 the life of the claim, utilizing reserve worksheets, ODG Guidelines, Workers' Computation software, and Davies Claims North America reserving philosophy

What We Are Looking For

  • College degree
  • Multiple years of experience handling several types of claims, including Workers' Compensation
  • Presumption claims handling experience
  • Experience with depositions, mediations, and litigation
  • Experience with IDatix, Reference Books-Periodicals, Workers Computation, ISO, and ShoreTel
  • FL-All Lines Adjuster or Workers' Compensation License, with ongoing CEU credits for license maintenance
  • Previous experience with settling claims
  • Proficiency in Microsoft Office Suite, particularly Excel

Nice to Have

  • 5+ years of Lost Time/Legal claims handling experience
  • Experience with EDI filings and rejections
  • Knowledge of MMSEA Section 111 Reporting requirements
  • Experience with vocational rehabilitation services

Benefits and Perks

  • Competitive salary
  • Comprehensive benefits package, including health, dental, and vision insurance
  • 401(k) plan with company match
  • Paid time off and holidays
  • Remote work stipend
  • Opportunities for professional growth and development
  • Collaborative and supportive work environment

How to Stand Out

  • Tip: Highlight your experience with Workers' Compensation claims, particularly in the state of Florida, and be prepared to discuss your understanding of relevant statutes and case law.
  • When applying, make sure to include specific examples of your claims handling experience, including successful outcomes and lessons learned.
  • To stand out, demonstrate your proficiency in Excel and other relevant software, such as IDatix and Workers Computation.
  • Be prepared to discuss your approach to reserve setting and claim valuation, and how you stay up-to-date with industry developments and best practices.
  • If you have experience with vocational rehabilitation services or EDI filings, be sure to highlight this in your application and during interviews.
  • Finally, be prepared to discuss your communication style and how you build relationships with clients, medical providers, and other stakeholders.

This is a remote position listed on WFA Digital, the platform for professionals who work from anywhere. Browse more remote jobs across all categories.