Workers’ Compensation Claims Adjuster

Description

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

• 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.