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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.
As part of Davies Specialty Programs, PGCS specializes in Third Party Claims Administration for Workers’ Compensation and Liability claims. We pride ourselves on our friendly, team-orientated work environment. Our energetic team, supportive leaders, and can-do attitude enhance a sense of collaboration and belonging in our teammates. Our focus is on quality, professional, superior service. This service-driven philosophy, conveyed throughout the organization, means we operate with the customers’ best interests at heart, constantly reinforcing our mission – Service Beyond the Contract.
Are you looking for a company that is Dynamic and Innovative where the teammates are Connected and Succeed Together? If so, Davies may just be the right choice for you.
Job Overview
USIS, Inc., part of Davies Specialty Programs, is looking for a WC Claims Specialist II to for the investigation, evaluation, disposition and settlement of Workers’ Compensation claims for the City of Miami, including complex and high exposure, and presumption (Heart & Lung) claims, with minimal supervision.
Opportunity to work from home.
Responsibilities and Duties:
- Analyze the claim exposure to determine the proper course of action and to appropriately settle or close the claim in accordance with state, company and client policy and procedure.
- 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.
- Perform other duties as assigned.
Experience and Qualifications
- A minimum of three years of Florida claims-related experience with a consistent high level of performance and achievement.
- A four-year college degree or equivalent work experience is preferred.
- Active Florida Adjuster License (5-24, 5-20 or 6-20).
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Knowledge, Skills and Abilities
- Experience in a claims environment handling lost time claims including litigated files.
- Extensive knowledge of accepted industry standards and practices including case law. Ability to successfully negotiate the settlement and disposition of claims, including the ability to interpret related documentation.
- Maintain knowledge of current trends, standards and law changes.
- Ability to effectively operate a personal computer and related claims and business software. Technically competent with systems. Familiarity with “paperless” work environment helpful.
- Must be self-directed and able to work independently.
- Ability to effectively present status updates in claims meetings with client.
- Good communication skills, both oral and written; good customer service skills.
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
- Paid Time Off, Sick Leave, and Paid Holidays
- Life insurance, short term, and long-term disability plans
- Amazing leadership and fabulous teammates
Position Type, Work Environment and Physical Demands
This is a home-based, full time, salaried, exempt position that predominantly operates remotely from a professional home-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.
