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Workers Compensation Adjuster - Remote FL

Charles Taylor
Remote, USA
Full-time
Mid Level
Remote
Discovered 1 months ago

Full Job Posting

  • Receives newly reported claims which include loss time, litigated and medical only
  • Maintains and updates claim notes throughout lifespan of claim
  • Records claim information in electronic database
  • Interviews claimants, insureds, medical professionals and witnesses to determine claim validity
  • Communicates claim compensability decisions to claimant, employer and medical provider
  • Sets appropriate reserves based on nature/extent of injury
  • Calculates lost time wages, makes disability payments directly to claimants and diaries future payments as appropriate
  • Orders independent medical examination as necessary and prepares all relevant documentation for physician review
  • Maintains regular correspondence with claimants, insureds, and nurse case manager to include claim updates, medical appointments, or issues with disability payments
  • Reviews and processes medical bills through third-party vendor for additional discount opportunities
  • Aggressively collaborates with claimants and insureds to ensure early return-to-work is pursued
  • Works in partnership with legal counsel to warrant that insured’s interests are protected on litigated claims which includes providing all relevant claim documentation needed for defense counsel to successfully defend claim and evaluate ultimate claim exposure
  • Attends settlement conferences, mediations, and hearings on behalf of the insurance company/insured
  • Reviews and approves defense attorney bills within authority
  • Works with underwriting to help provide relevant information on losses for renewal rates as well as Risk Management to identify trends and may interact with agents for insureds on losses
  • Responds to State requests for health cost disputes, applications for hearings and penalty assessment letters
  • Identifies subrogation potential and pursues recovery
  • Leads claim reviews with clients as requested
  • Other duties as assigned
  • 3-5 years of experience adjusting Workers Compensation Claims in Florida
  • Hold a current FL adjusters license
  • Must be current with CEU's
  • Proficiency in entire Microsoft Office suite
  • Knowledge of relevant workers compensation laws
  • Strong grasp of medical terminology
  • Familiarity with medical cases and how treatment typically progresses
  • Excellent oral and written communication abilities
  • Attention to detail and good organization skills
  • Ability to negotiate issues and settlements
  • Strong focus on customer service which includes timely response to requests/inquiries
  • Ability to adapt to changing technologies and learn functionality of new equipment and systems
  • Ability to establish and maintain effective working relationships with others

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