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Workers' Comp Litigated Claims Specialist 

Davies · Home, Estados Unidos De América · Remote

  • Professional
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Our Story
Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

What’s in Store
We're on the lookout for a Workers’ Compensation Legal Adjuster to join our growing team in Florida! As a Workers’ Compensation Legal Adjuster, you will investigate assigned Florida Workers’ Compensation claims, evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim while setting appropriate reserves. You will also provide benefits and initiate state filings promptly while exercising discretion and independent judgement.

Key Responsibilities

  • Investigate claims to determine compensability and manage appropriate reserve levels.
  • Oversee and direct defense counsel in litigated matters; make strategic litigation decisions.
  • Process indemnity payments and authorize medical treatment per FL Statute 440.13.
  • Monitor medical care and coordinate with Nurse Case Managers, medical providers, and employers on RTW and light duty.
  • Ensure timely and compliant state and EDI filings; manage EDI rejections in coordination with EDI adjusters.
  • Evaluate and process medical bills; identify subrogation and recovery opportunities.
  • Maintain file documentation, diaries, and reserve worksheets in accordance with Davies’ best practices.
  • Ensure Medicare compliance per MMSEA Section 111.
  • Maintain a 97% claim closure rate and support client communication and satisfaction.

Skills, knowledge & expertise

  • 3-5 years of Lost Time/Legal claims handling experience
  • Possess FL-All Lines Adjuster or Workers’ Compensation License and maintain CEU credits for license
  • Previous experience with settling claims
  • In-depth knowledge of Florida Workers’ Compensation laws and litigation process.
  • Experience managing litigated claims with strategic oversight.
  • Strong communication, negotiation, and analytical skills.
  • Experience with IDatix, Reference Books-Periodicals, Workers Computation, ISO, ShoreTel a plus 

Benefits

Benefits
At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:
  • 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 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.
 
Diversity and Inclusion
Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.