Workers Compensation Lost Time Adjuster (Remote)

Davies Group; Florida; Teletrabalho; USD 68 000 - 75 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, dental, and vision plans

401(k) with employer matching

Paid time off and holidays

Life insurance

Short-term and long-term disability

Resumo da oferta

Davies North America is seeking a Workers’ Compensation Legal Adjuster to investigate Florida claims, evaluate case details, and determine compensability and reserves for the claim. This remote role supports a team focused on timely indemnity payments and state filings while coordinating with defense counsel and medical providers.

The position requires 3–5 years of Lost Time/Legal claims handling, an active FL All-Lines Adjuster or WC license, and strong communication skills.

Qualificações

• 3-5 years of Lost Time/Legal claims handling experience; preferred 5+ years.
• Possess FL-All Lines Adjuster or Workers’ Compensation License and CEU credits for license
• Previous experience with settling claims
• Experience with Microsoft Office Suite
• Proactive, independent, and takes initiative with consistent follow through
• Superior time management skills with capability of working with and meeting deadlines
• Excellent team player with interpersonal skills
• Capable of working collaboratively and independently with minimal supervision
• Exhibit discretion with sensitive and confidential information

Responsabilidades

• 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

Conhecimentos

Lost Time claims

FL Adjuster license

Florida law knowledge

MS Office

Communication skills

Formação académica

College degree

Ferramentas

IDatix

Reference Books-Periodicals

Workers Computation

ISO

ShoreTel

Descrição da oferta de emprego

Workers Compensation Lost Time Adjuster (Remote)

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Workers' Compensation Claims Supervisor

Compensation: $68,000 - $74,800 / year

Description

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.

Key Responsibilities

• 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

Skills, knowledge & expertise

• 3-5 years of Lost Time/Legal claims handling experience; preferred 5+ years
• Possess FL-All Lines Adjuster or Workers’ Compensation License and maintain CEU credits for license
• Previous experience with settling claims
• Experience with Microsoft Office Suite
• 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

Preferred

• College degree
• Multiple years’ experience handling several types of claims
• Presumption claims handling experience
• Experience with depositions, mediations, and litigation
• Experience with IDatix, Reference Books-Periodicals, Workers Computation, ISO, ShoreTel

Equal Employment Opportunity & Legal Notices

Benefits

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
• Paid holidays
• Life insurance and short‑term and long‑term disability coverage

Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location.

Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.

Diversity and Inclusion

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.

Compensation Transparency: The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.

Essential Functions

• Maintain regular and dependable attendance.
• Be available and able to perform job responsibilities during established work hours.

Background Check & Fair Chance Compliance

Any background check or review of criminal history, if applicable to the role, will be conducted only after a conditional offer of employment and in compliance with applicable federal, state, and local laws, including fair‑chance hiring requirements.

Massachusetts Notice

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

AI Policy

At Davies, we value authentic conversations and a fair candidate experience. While candidates may use AI and technology tools to prepare for interviews, we expect interview responses and assessments to reflect each individual's own experience, knowledge, and professional judgment.

We do not use sites like Facebook, Craigslist, or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal, please email us at [e-mail]