Workers Compensation Claim Adjuster

Job Description

Job Description

Description

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 Claim 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

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 :

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.

Compensation Transparency :

The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.