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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.
We’re currently seeking an experienced Workers’ Compensation Claims Adjuster to join our growing team. In this role, you’ll manage Florida workers’ compensation claims, including litigated files, while ensuring compliance with Florida statutes and delivering exceptional service to our clients.
This position will investigate and manage Florida workers’ compensation claims from assignment through resolution. You’ll evaluate claim details, apply Florida statutes and case law to determine compensability, and establish appropriate reserves while ensuring timely payments and regulatory compliance.
You’ll collaborate with defense counsel, nurse case managers, and clients while managing litigation strategy and maintaining a proactive approach to claim resolution.
Key Responsibilities
- Investigate and evaluate Florida workers’ compensation claims to determine compensability, exposure, and total claim value in accordance with Florida statutes and case law.
- Establish and maintain appropriate reserves using reserving tools, ODG guidelines, and company reserving philosophy.
- Initiate and manage indemnity payments and maintain diary systems for ongoing payments and claim activity.
- Complete state-required filings and EDI reporting accurately and within required timelines.
- Assign and coordinate with defense counsel on litigated claims and assist with litigation strategy.
- Collaborate with Nurse Case Managers to monitor medical treatment and authorize appropriate medical services under Florida Statute 440.13.
- Review and approve medical bills within required timeframes.
- Determine need for vocational rehabilitation services to assist injured employees with return-to-work planning.
- Coordinate light duty opportunities and workplace accommodations with employers and medical providers.
- Maintain consistent communication with clients and attend client meetings as required.
- Maintain accurate documentation, diaries, and workflow management to ensure regulatory compliance.
- Identify potential subrogation or recovery opportunities and pursue appropriate reimbursement from responsible parties.
- Protect Medicare’s interests and ensure compliance with MMSEA Section 111 reporting requirements.
- Monitor claims for red flags or potential fraud indicators.
- Request reimbursement from excess carriers as required and follow up on outstanding recoveries.
- Escalate client concerns or E&O risks to leadership when appropriate.
- Maintain performance expectations, including a 97% claim closure ratio.
Skills, knowledge & expertise
- Workers’ compensation claims handling experience, including lost time and litigated claims
- Active Florida All-Lines Adjuster License or Florida Workers’ Compensation License
- Experience evaluating claims, setting reserves, and managing litigation files
- Strong knowledge of Florida Workers’ Compensation statutes and rules
- Experience coordinating with defense counsel and nurse case managers
- Proficiency with Microsoft Office Suite
- Excellent written and verbal communication skills
- Strong organization, prioritization, and time-management skills in a fast-paced environment
- Ability to work independently while collaborating with a team
- Experience handling multiple claim types or presumption claims
- Experience with depositions, mediations, and settlement negotiations
- Familiarity with systems such as IDatix, Workers Computation, ISO, or ShoreTel
Benefits
Benefits
At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:
- Medical, dental, and vision plans to ensure your health and that of your family.
- A 401k plan with employer matching to help you build a secure financial future.
- Our time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
- Paid holidays.
- Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.
Massachusetts NoticeIt 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.
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.
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 recruitment@davies-group.com
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.
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 recruitment@davies-group.com
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