Lost Time Workers Compensation Claims Adjuster

Key Responsibilities

• 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.

Skills, knowledge & expertise

• Active Adjuster license (FL 5-24, 5-20 or 6-20).
• 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.

• 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 clients, etc.
• Good communication skills, both oral and written; good customer service skills.
• Assertive self-starter with excellent organizational skills. Team player. Good attendance.

Equal Employment Opportunity & Legal Notices

• 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