Senior Workers' Comp Adjuster
- Employer
- Davies Claims Solutions
- Location
- Orlando, Florida
- Salary
- Salary commensurate with experience. Excellent benefits package offered.
- Closing date
- Sep 18, 2021
View more
- Category
- Claims
- Job Type
- Full Time
- Career Level
- Experienced (Non-Manager)
Job Details
SUMMARY
Investigates and evaluates losses while developing a plan of action to bring claims to proper resolution in a timely manner. Experience level preferably between 5-7 years in FL Workers Compensation claims.
JOB REQUIREMENTS:
- Confirms coverage and addresses compensability and causation on each claim
- Investigates claims, including interviewing employees, employers and witnesses
- Obtains necessary records, including but not limited to, hospital/physician records, police reports, etc.
- EDI state filings and CMS/Section 111 reporting
- Utilizes appropriate preferred vendors
- Presents thorough and accurate reports to clients and excess carriers on claims investigations/status updates
- Negotiates settlements for resolution with claimants or their attorneys
- Maintains control of litigation activities and costs per account requirements
- May be asked to mentor, train and/or share expertise with other ASC staff
- May be asked to serve as back up to supervisor or manager when they are unavailable
- Attends meetings; conferences; workshops or training sessions; and reviews written
material to maintain current knowledge on principles, practices and new developments
in assigned work areas
- Maintains and meets state specific licensing requirements
- Responds to client questions and comments in a courteous and timely manner
- Participates in client meetings, both telephonic and face to face
- Is responsible for catastrophic losses, complex litigation, and other sensitive issues
- All other duties as assigned
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
- Ability to understand and follow oral and/or written policies, procedures and instructions
- Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
- Ability to conduct investigations in multi-party situations
- Ability to use standard or customized software applications appropriate to assigned tasks
- Ability to prepare and present accurate, reliable and factual reports with recommendations
- Thorough knowledge of current principles and practices associated with claims investigations, adjustment and related practices
- Extensive knowledge of medical and legal terminology with a thorough understanding of
legal principles/litigation management
- Ability to handle confidential information
- Ability to communicate effectively with others both orally and in writing
- Ability and willingness to learn quickly and utilize new skills as a result of rapidly
changing information and/or technology
- Ability to comprehend multi-state laws and regulations to assist other offices, as necessary
Required Experience:
Should have 5-7 years experience in handling Florida workers’ compensation claims. A
college degree or equivalent business experience needed.
Company
Davies Claims Solutions provides TPA services for a variety of insurance clients and self-insured entities including public entities and private employers with employees in many states.
The workers’ compensation TPA claims handling process includes a number of services such as nurse case management, nurse triage, medical bill review, pharmacy benefit management, telemedicine, medical provider options, return-to-work initiatives, peer review, utilization review and more.
As a TPA, we provide a number of flexible client options, such as choice of nurse case management, medical provider access with PPO networks or Alternative Cost Containment, and a choice of surveillance and claims investigation. We also offers telemedicine as a managed care solution.
Our U.S. claim adjusters, have an average of 25 years of industry experience. We have a strong track record of delivering excellent financial outcomes for our clients such as averaging indemnity savings of almost a third through our pharmacy benefit management.
- Website
- http://www.ascrisk.com/
- Location
-
2501 McGavock Pike, Suite 802
Nashville
TN
37214
US
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