Medical Only Adjuster - Lakewood Ranch, United States - Davies Claims North America

Davies Claims North America

Verified Company

Lakewood Ranch, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

About Us
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.

Are you looking for a company that is Dynamic and Innovative where the employees are Connected and Succeed Together? If so, Davies may just be the right choice for you._

Job Overview

Davies Claims North America is looking for a
Medical Only Adjuster who is interested in developing their skills and working in the exciting and fast-paced workers' compensation industry.

Reporting to the WC Claims Manager and/or WC Claims Supervisor, you will conduct thorough investigations of assigned workers' compensation claims, provide benefits, and initiate State filings timely while exercising discretion and independent judgement.

To be successful in this role, you need to be focused on detail, have a customer-centric philosophy, and have the desire to develop skills both personally and professionally.

You must have a bachelor's degree or four or more years of equivalent work experience, exhibit strong organizational skills, and must possess an active Florida All-Lines or Workers' Compensation license.

Additionally, you will need to have proven critical thinking skills that demonstrate analysis, judgement, sound decision making with focus on attention to details, great customer service skills, and excellent communication skills (both written and verbal).

This role is a full-time, hybrid (onsite and remote) position based out of Lakewood Ranch, FL.

Responsibilities and Duties

Investigate claims by interviewing claimant, employer, witnesses, and physicians
Determine compensability and total value of claim
Monitor medical treatment in conjunction with Medical Management personnel
Promptly approve medical bills for payment
Provide prompt authorization of medical services
Coordinate light duty availability with medical providers and employers
Maintain adequate reserves for life of claim
Convey positive attitude and team spirit for optimum provision of services to customers
Attend client meetings as necessary
Determine subrogation potential and pursue recovery where applicable
Maintain acceptable claim closure ratio
Negotiate settlement of claim if warranted
Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
Perform other duties as assigned by the Claims Supervisor, Assistant Claims Manager, Training Coordinator, Claims Manager, or QA Manager

Experience and Qualifications
Required

Sustain working knowledge of workers' compensation law, rules, procedures, case law, liability principles, and medical terminology and procedures
Maintain diary and workflow processes
Review of claims for possible red flags
Identify and pursue subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden
Must maintain claim closure of at least 97%
Reporting of any overall account or client concerns to the supervisor or upper management
Must maintain required CEU credits
Proficiency in Microsoft Word, Excel, and Outlook
Florida All-Lines Adjuster License or Workers Compensation License

Preferred

Experience with IDatix, Reference Books-Periodicals, Workers Computation, ISO, and ShoreTel
Experience with Lost Time, Litigation, Mediation, and/or Depositions
Familiarity with government municipalities
Experience with Medical Only or Workers' Compensation claims

Knowledge, Skills, and Abilities

Proactive, independent, and takes initiative with consistent follow through
Superb communication skills, verbal and written, conducted in a timely manner
Superior time management skills with capability of working with and meeting deadlines
Exceptional capability to multitask and prioritize with excellent organization and documentation skills in a fastpaced, dynamic work environment
Excellent team player with interpersonal skills
High level attention to detail and problemsolving skills
Capable of working collaboratively and independently with mínimal supervision
Exhibit discretion