Medical Only Adjuster

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 Adjusterwho is interested in developing their skills and working in the exciting and fast-paced workers’ compensation industry. Reporting to the 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, home based position working remotely from a professional home-based environment.

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, 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 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
• Capable of working collaboratively and independently with minimal supervision
• Exhibit discretion with sensitive and confidential information
• Display a comfort level working with key people at all levels within an organization

Essential Requirements

• Must have US work rights
• Must speak English
• Must maintain working knowledge of workers’ compensation law, rules, procedures, case law, liability principles, and medical terminology and procedures
• Must maintain required CEU credits
• Must be proficient in Microsoft Word, Excel, and Outlook
• Must possess a Florida All-Lines Adjuster License or Workers Compensation License

Other Duties

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the individual for this job and is subject to change with or without notice.

Diversity and Inclusion

Davies is committed to being a diverse and inclusive workplace. We welcome candidates of all genders, gender identity and expression, neurodiversity, sexual orientation, disability, physical appearance, body size, race, age, nationality, and belief (or lack thereof).

Rewards and Recognition

We embrace innovation and run an annual competition available for all colleagues to submit their ideas. The top finalists travel to the current year’s competition site where they pitch their ideas to our investors. The winner receives funding to bring their idea to life and the runners up receive a reward for their involvement. Some of our teammates have moved across into brand new positions to further develop their ideas/projects!

Benefits

• Medical, dental, and vision plans
• 401k plan with employer matching
• Discretionary Time Off (Vacation & Safety/Sick Leave) and Paid Holidays
• Life insurance, short term, and long-term disability plans
• Amazing Executive and Senior leadership as well as fabulous teammates

Position Type, Work Environment and Physical Demands

This is a full-time, home-based position working remotely from a professional home-based environment, routinely operating and using standard office equipment such as computers, phones, printers, photocopiers, and scanners and requires prolonged periods of sitting at a desk while working on a computer. While performing the duties of this job, the individual will be required to regularly hear and talk. This is a largely sedentary role requiring the ability to sit at a desk, reach outward, use a phone, have use of fingers to operate office equipment such as a keyboard, mouse, phone, printer, copier, and to reach above the head, bend, or stand as necessary.

Location

Davies Claims North America is currently able to support employees residing in the following US locations: Florida, Maryland, D.C., Virginia, Pennsylvania, New Jersey, Delaware, North Carolina, South Carolina, Connecticut, Massachusetts, Rhode Island, New Hampshire, Vermont, Maine, and Texas. If you live in—or are willing to relocate at your own expense to—any of the listed locations, we look forward to your application! If there is a required or preferred location for an open role, it will be listed in the job description. Should your state not be listed, please visit https://davies-group.com/location/ to locate a subsidiary near you.