Senior WC Claim Adjuster

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

• Must reside within the state of Maryland
• 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 
• 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 

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