Workers Compensation Lost Time Adjuster (Remote)

We are looking for a Workers' Compensation Legal Adjuster to join our growing team remotely from Home, Alabama. As a Workers' Compensation Legal Adjuster, you will investigate assigned Florida Workers' Compensation claims, evaluate claim details, including Florida Statute and case law, to determine compensability and total value of the claim while setting appropriate reserves.

Key Responsibilities

• Evaluate claim details, including Florida Statute and case law, to determine compensability and total value of the claim; set and adjust reserves accordingly
• Initiate investigation and assign defense counsel when appropriate
• Initiate accurate indemnity payments in a timely manner and maintain a diary for ongoing payments
• Complete state filings in a timely and proper manner
• 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
• 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 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, 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 a 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

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