Address
SalaryAs a Workers’ Compensation Claims Specialiston our team, you would be responsible for investigation, evaluation, disposition and settlement of Workers’ Compensation claims for self-insured or public entity accounts, including complex and high exposure claims. This includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Opportunity to work from home.
What You’ll Be Doing:
- Analyze the claim exposure to determine the proper course of action and to appropriately settle or close the claim in accordance with state, company and client policy and procedure.
- 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.
- Evaluate files for reserve potential and for settlement (effective knowledge of MSAs and structured annuities).
- 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.
- 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.
- Perform other duties as needed.
What You’ll Need:
- A minimum of three years of Florida claims-related experience with a consistent high level of performance and achievement.
- Experience in a claims environment handling Lost Time claims including litigated files.
- 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.
- Active Adjuster license (FL 5-24, 5-20 or 6-20) required.
- Ability to effectively operate a personal computer and related claims and business software. Familiarity with “paperless” work environment helpful.
- Good communication skills, both oral and written; good customer service skills.
- Assertive self-starter with excellent organizational skills. Team player. Good attendance.
- Ability to work accurately in a fast-paced position ensuring all policies and procedures are managed to expected timeframes.
What We Offer:
- Generous Paid Time Off, plus Floating Holiday, Culture Day and 10 regular company-paid holidays.
- Generous benefits package, including medical, dental vision, life insurance, etc.
- 401(k) plan with company match
- Compensation: $65,000 to $70,000 based on experience.
Who We Are:
At Davies, we get it... you are not just looking for a job, you are looking to build a life and a career. We believe in our people and realize that our success is a direct result of creating a learning atmosphere, leadership opportunities, and promoting from within. We believe that engaging in corporate social activities and working together as a team is a vital part of the Davies culture.
With a multinational global team, Davies Group is a specialist professional services and technology firm working in partnership with leading insurance, highly regulated, and global businesses. At Davies Group, we help clients to manage risk, operate core business processes, and to transform and grow. We deliver operations, consulting and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation, customer experience, human capital, transformation, and change management.
As part of Davies Specialty Programs, USIS specializes in Third Party Claims Administration and Medical Management for Workers’ Compensation and Liability claims. We pride ourselves on our friendly, team-orientated work environment. Our energetic team, supportive leaders, and can-do attitude enhance a sense of collaboration and belonging in our teammates.
Our focus is on quality, professional, superior service. This service-driven philosophy, conveyed throughout the organization, means we operate with the customers’ best interests at heart, constantly reinforcing our mission – Service Beyond the Contract.
Davies is committed to being a diverse and inclusive workplace. We welcome candidates of all genders, gender identity and expression, neurodiversity, sexual orientation, disability, physical appearance, body size, race, age, nationality, and belief (or lack thereof).
We are an Equal Opportunity Employer. We take pride in the diversity of our team and seek diversity in our applicants.
