Worker's Comp Medical Only Adjuster na Davies
Davies · Lakewood Ranch, Estados Unidos Da América · Remote
- Professional
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.
We are looking for a Medical Only Adjuster to join our team in Florida! In this role, you will be responsible for the investigation, evaluation, and management of assigned Workers’ Compensation Medical Only claims. You will ensure timely and accurate administration of benefits, compliance with state regulations, and effective coordination of medical care while exercising sound judgment and independent decision-making in all aspects of claim handling.
Key Responsibilities
- Conduct initial investigation of assigned medical-only claims, including prompt contact with the employee, employer, and medical provider within 48 hours of assignment.
- Review and analyze claim details, medical documentation, and applicable state statutes to determine compensability.
- Authorize and process medical treatment and payments in accordance with state law and client-specific guidelines.
- Maintain timely and accurate documentation of all claim activities in the claims management system.
- Monitor ongoing medical treatment and coordinate with Nurse Case Managers, when assigned, to ensure appropriate and cost-effective care.
- Maintain consistent communication with injured employees, employers, and providers to facilitate a safe and timely return to work.
- Ensure compliance with statutory reporting and filing requirements, including EDI transactions and state forms.
- Identify potential subrogation opportunities and refer to the appropriate party for recovery efforts.
- Set and maintain adequate medical reserves in accordance with company and client standards.
- Adhere to client profile instructions and service level expectations.
- Maintain diary and workflow requirements to ensure timely claim progression and closure.
- Attend client meetings and training sessions as required to support client relationships and professional development.
- Maintain required CEU credits and participate in continuing education as directed by management.
- Perform other duties as assigned by the Claims Supervisor or Claims Manager.
- Promote a positive team environment and demonstrate a commitment to excellent customer service.
Skills, knowledge & expertise
- Working knowledge of workers’ compensation laws, rules, and procedures, as well as medical terminology and treatment protocols.
- Strong communication, organization, and negotiation skills.
- Ability to manage multiple priorities while maintaining accuracy and compliance.
- Proficiency with claims management systems and Microsoft Office applications.
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.
