Davies
Overview
Davies North America is seeking a
Workers' Comp Litigated Claims Specialist
to join our team. The role involves investigating Florida workers’ compensation claims, evaluating detail including Florida Statute and case law, determining compensability and total value, and setting appropriate reserves. The position requires discretion and independent judgment and involves benefits processing and timely state filings. 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 return-to-work 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 high rate of claim closures 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
Medical, dental, and vision plans for you and your family 401k plan with employer matching Discretionary Time Off for exempt employees and Paid Time Off (PTO) for non-exempt employees Paid holidays Life insurance and short-term/long-term disability plans Diversity and Inclusion
Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We promote an environment where all voices are valued and heard. Details
Seniority level: Associate Employment type: Full-time Job function: Administrative Industries: Insurance Location: Lakewood Ranch, FL (United States) – Open to candidates in the region; bonuses and salary ranges may vary by location.
#J-18808-Ljbffr
Davies North America is seeking a
Workers' Comp Litigated Claims Specialist
to join our team. The role involves investigating Florida workers’ compensation claims, evaluating detail including Florida Statute and case law, determining compensability and total value, and setting appropriate reserves. The position requires discretion and independent judgment and involves benefits processing and timely state filings. 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 return-to-work 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 high rate of claim closures 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
Medical, dental, and vision plans for you and your family 401k plan with employer matching Discretionary Time Off for exempt employees and Paid Time Off (PTO) for non-exempt employees Paid holidays Life insurance and short-term/long-term disability plans Diversity and Inclusion
Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We promote an environment where all voices are valued and heard. Details
Seniority level: Associate Employment type: Full-time Job function: Administrative Industries: Insurance Location: Lakewood Ranch, FL (United States) – Open to candidates in the region; bonuses and salary ranges may vary by location.
#J-18808-Ljbffr