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Role Description

We’re currently seeking an experienced Workers’ Compensation Legal Adjuster to join our growing team. In this role, you’ll manage Florida workers’ compensation claims, including litigated files, while ensuring compliance with Florida statutes and delivering exceptional service to our clients.

This position will investigate and manage Florida workers’ compensation claims from assignment through resolution. You’ll evaluate claim details, apply Florida statutes and case law to determine compensability, and establish appropriate reserves while ensuring timely payments and regulatory compliance.

You’ll collaborate with defense counsel, nurse case managers, and clients while managing litigation strategy and maintaining a proactive approach to claim resolution.

Key Responsibilities

• Investigate and evaluate Florida workers’ compensation claims to determine compensability, exposure, and total claim value in accordance with Florida statutes and case law.
• Establish and maintain appropriate reserves using reserving tools, ODG guidelines, and company reserving philosophy.
• Initiate and manage indemnity payments and maintain diary systems for ongoing payments and claim activity.
• Complete state-required filings and EDI reporting accurately and within required timelines.
• Assign and coordinate with defense counsel on litigated claims and assist with litigation strategy.
• Collaborate with Nurse Case Managers to monitor medical treatment and authorize appropriate medical services under Florida Statute 440.13.
• Review and approve medical bills within required timeframes.
• Determine need for vocational rehabilitation services to assist injured employees with return-to-work planning.
• Coordinate light duty opportunities and workplace accommodations with employers and medical providers.
• Maintain consistent communication with clients and attend client meetings as required.
• Maintain accurate documentation, diaries, and workflow management to ensure regulatory compliance.
• Identify potential subrogation or recovery opportunities and pursue appropriate reimbursement from responsible parties.
• Protect Medicare’s interests and ensure compliance with MMSEA Section 111 reporting requirements.
• Monitor claims for red flags or potential fraud indicators.
• Request reimbursement from excess carriers as required and follow up on outstanding recoveries.
• Escalate client concerns or E&O risks to leadership when appropriate.
• Maintain performance expectations, including a 97% claim closure ratio.

Qualifications

• Workers’ compensation claims handling experience, including lost time and litigated claims.
• Active Florida All-Lines Adjuster License or Florida Workers’ Compensation License.
• Experience evaluating claims, setting reserves, and managing litigation files.
• Strong knowledge of Florida Workers’ Compensation statutes and rules.
• Experience coordinating with defense counsel and nurse case managers.
• Proficiency with Microsoft Office Suite.
• Excellent written and verbal communication skills.
• Strong organization, prioritization, and time-management skills in a fast-paced environment.
• Ability to work independently while collaborating with a team.
• Experience handling multiple claim types or presumption claims.
• Experience with depositions, mediations, and settlement negotiations.
• Familiarity with systems such as IDatix, Workers Computation, ISO, or ShoreTel.

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.
• Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) package for non-exempt employees.
• Paid holidays.
• Life insurance and both short-term and long-term disability plans.