MDD Forensic Accountants

Making Numbers Make Sense

Workers’ Compensation Legal Adjuster

AttorneyAttorneyFull TimeRemoteTeam 201-500Since 1933H1B No SponsorCompany SiteLinkedIn

Location

Florida

Posted

6 days ago

Salary

$65K - $70K / year

English

Job Description

• 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.

Job Requirements

  • 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.
  • Our time-off policies, including Discretionary Time Off (DTO) 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.

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