Job Description
Note: The job is a remote job and is open to candidates in USA. Davies North America is at the forefront of innovation and excellence in the insurance sector, seeking a Workers’ Compensation Lost Time Adjuster. The role involves conducting thorough investigations of Workers’ Compensation claims, providing benefits, and ensuring timely state filings while exercising independent judgment and discretion.
Responsibilities
- Adjust claims for assigned Davies North America clients
- Investigate claims by completing 24-hour contact with employee, employer, physician(s), and witnesses
- Evaluate claim detail, Illinois Statute, and case law to determine compensability and total value of claim
- Display capability of setting and adjusting reserve amounts accordingly
- Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments
- Ensure timely and proper completion of all required State filings
- Handle EDI filings and rejections in conjunction with EDI adjuster
- Monitor medical treatment in conjunction with the assigned Nurse Case Manager
- Review, document and approve medical bills for payment within three days of receipt
- Authorize appropriate medical services as appropriate
- Maintain regular telephone contact with injured employees
- Determine whether vocational rehabilitation services are needed for an employee to return to work
- Coordinate light duty availability and reasonable accommodations with medical providers and employers
- Maintain adequate reserves for life of claim utilizing reserve worksheets, ODG Guidelines, Workers’ Computation software, and Davies North America’s reserving philosophy
- Attend client meetings as necessary, and maintain regular telephone contact to ensure client satisfaction
- Evaluate cases and negotiate settlements when appropriate, protecting Medicare’s interests
- Review 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
- Make timely notice to the excess carrier in all cases while meeting reporting criteria and keeping the carrier updated on claim status
- Request reimbursement at least quarterly and follow up for timely receipt from excess carrier(s)
- Adhere to client profile instructions
- Report any overall account or client concerns to the supervisor or upper management
- Report any E&O concerns
- Attend claims meetings at client locations, client visits, seminars for obtaining CEU credits
- Interact with Managers, Training Coordinator, Supervisors, Adjusters, Nurse Case Managers, Team Assistants, Employers, Injured Workers, Medical Providers, Ancillary Providers, State Employees, Insurance Carriers, Excess Carriers, and Brokers as needed
Skills
- 1 to 3 years handling Illinois Workers' Compensation claims
- Maintain diary and workflow requirements
- Maintain 97% claim closure ratio
- Maintain working knowledge of Illinois Workers' Compensation Statute and Rules, and their application
- College degree or equivalent work experience
- 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 multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment
- Excellent team player with interpersonal skills
- High level attention to detail and problem-solving skills
Benefits
- 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.
Company Overview
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