Job Closed

This listing is no longer active.

MDD Forensic Accountants logo
MDD Forensic Accountants

Making Numbers Make Sense

Workers' Compensation Claims Adjuster

Claims SpecialistClaims SpecialistFull TimeRemoteSeniorTeam 201-500Since 1933H1B No SponsorCompany SiteLinkedIn

Location

Florida

Posted

29 days ago

Salary

$80K - $85K / year

Seniority

Senior

Bachelor Degree3 yrs expEnglish

Job Description

Workers' Compensation Claims Adjuster

MDD Forensic Accountants

• Investigate assigned Florida Workers’ Compensation claims • Evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim while setting appropriate reserves • Provide benefits and initiate state filings promptly while exercising discretion and independent judgement • Initiate investigation and assign defense counsel when appropriate • Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments • Handle EDI filings and rejections in conjunction with EDI adjuster • Monitor medical treatment in conjunction with assigned Nurse Case Manager • Review, document, and approve medical bills for payment within three days of receipt • Authorize appropriate medical services as outlined per Florida Statute 440.13 • 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 Claims North America reserving philosophy • Attend client meetings as necessary, and maintain regular telephone contact to ensure client satisfaction • Maintain diary and workflow requirements • Maintain working knowledge of FL Workers’ Compensation Statutes and Rules, and their application • Direct defense counsel in handling of litigation claims • With defense input, make timely decisions regarding litigated issues • Protect Medicare’s interest in conjunction with MMSEA Section 111 Reporting requirements • Review claims for possible red flags • Demonstrate capability of identifying and pursuing subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden • 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 to the QA Manager and Executive Vice President • Maintain 97% claim closure ratio

Job Requirements

  • 3-5 years of Lost Time/Legal claims handling experience; preferred 5+ years
  • Possess FL-All Lines Adjuster or Workers’ Compensation License and maintain CEU credits for license
  • Previous experience with settling claims
  • Experience with Microsoft Office Suite
  • 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

Benefits

  • Medical, dental, and vision plans to support your health and that of your family
  • A 401(k) plan with employer matching
  • Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
  • Paid holidays
  • Life insurance and short‑term and long‑term disability coverage
  • Paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements
  • Diversity and inclusion initiatives

Related Categories

Related Job Pages

More Claims Specialist Jobs

Gallagher logo

Lead General Liability Claims Adjuster

Gallagher

Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on protected characteristics by applicable federal, state, or local laws.

Full TimeRemoteTeam 5,001-10,000

Role Description At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose. Role specifics: - Claims Background: Commercial General Liability - Jurisdictional Experience: Any - Active Adjusters' licenses: New York - Location: This role is eligible for fully remote work How you'll make an impact: - Apply claims management experience to execute decision-making to analyze claims exposure and litigation, plan the proper course of action, and appropriately resolve claims. - Interact extensively with various parties involved in the claim process to ensure effective communication and resolution. - Provide exceptional customer service to our claimants on behalf of our clients exhibiting empathy through each step of the claims process. - Handle claims consistent with clients' and corporate policies, procedures, and standard methodologies in accordance with statutory, regulatory, and ethics requirements. - Document and communicate claim activity timely and efficiently, supporting the outcome of the claim file. About You: As a key member of our Claims Adjuster team, you will: - Investigate, evaluate, and resolve complex Construction General Liability claims, applying your claims experience and analytical skills to make informed decisions and bring claims to resolution. - Work in partnership with our clients to deliver innovative solutions and enhance the claims management process. - Think critically, solve problems, plan, and prioritize activities to optimally serve clients. Qualifications - High School Diploma. - Minimum of 5 years related claims experience. - Appropriate licensing and/or certification in all states in which claims are being handled. - Knowledge of accepted industry standards and practices. - Computer experience with related claims and business software. Requirements - Bachelor's Degree (Desired) - Construction Bodily Injury and Property Damage - 3rd Party (Desired) - NYLL (Desired) - Large Loss/Major Case (Desired) - Litigation (Desired) - Trainer/Mentee (Desired) Benefits We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. - Medical/dental/vision plans, which start from day one! - Life and accident insurance - 401(K) and Roth options - Tax-advantaged accounts (HSA, FSA) - Educational expense reimbursement - Paid parental leave - Digital mental health services (Talkspace) - Flexible work hours (availability varies by office and job function) - Training programs - Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing - Charitable matching gift program - And more...

Pennsylvania
$77K - $110K / year
Job Closed

Adjuster

Agricorp

Agricorp, an agency of the government of Ontario, delivers government programs that help protect the livelihood of over 47,000 Ontario farmers against the many risks farm businesses face every day. Our employees are skilled professionals who respond when industry and government need us, manage public funds with great care and integrity, and deliver a quality customer experience. Agricorp helps grow Ontario agriculture. We underwrite $6-8 billion in risk each year. The agency was established in 1997, and since then we’ve made over $8 billion in payments to farmers when they needed it most. Please advise if you require accommodation during the recruitment process. We thank all applicants for their interest; however, only those selected for an interview will be contacted directly.

Role Description Agricorp is looking for Adjusters to join our Regional Services team in Eastern Ontario. This opportunity will appeal to those interested in representing Agricorp locally in the area including but not limited to the counties of Prescott and Russell, Renfrew, Lanark and adjoining counties. Crop knowledge & specialties include Grains & Oilseeds and forages. The role is a part-time contract position that requires availability that varies throughout the year depending on season & workloads. This may include work assigned from other regional areas when required. This role works from a remote home office. Adjusters use their local knowledge of clients, crops and agronomics to act as the key Agricorp resource for the inspection of crops, investigation and settlement of claims, audits and other local services. In this role, you will: - Handle enrolment, underwriting assessments, contract establishment, premium collection, claims adjudication and settlement activities for assigned clients - Conduct inspections and audits, including damage report investigations, seasonal crop inspections, yield claims, acreage and application of losses due to uninsured perils - Provide agronomic and crop plan knowledge and expertise to other departments or projects as required - Perform other adjusting duties as required Qualifications - Post-secondary education in agriculture or equivalent experience - Minimum 3 years’ of related experience in farming or in the agricultural industry with a specialization in crop production - Knowledge of Ontario agronomy and the management and marketing of local crops - Demonstrated ability to communicate with diverse stakeholders using influence and authority - Valid driver’s license - Proficiency in Microsoft Office - Certified Crop Advisor (CCA), an asset - French language required for Prescott and Russell county and an asset for the other counties Requirements - Quality Focus: Attends to task at hand to minimize errors and provide consistent delivery of work to the highest possible standard; prior to work being distributed - Client focus: Meets the expectations of internal and external customers through establishing effective relationships, gaining trust and respect - Information gathering: Locates and collects data from appropriate sources and analyzes it to summarize in reporting - Initiative: Proactively identifies and handles issues and situations to take action; seizing opportunities when they arise - Efficiency: Effectively plan and organize time and resources to prioritize work to effectively meet objectives - Program knowledge: Knows and understands the programs and services provided by Agricorp Benefits - 2 contract positions (posting for an existing vacancy) - Salary: $33.85/hour - Location: Eastern Ontario regions (Prescott and Russell, Renfrew, Lanark and adjoining counties) Company Description Agricorp, an agency of the government of Ontario, delivers government programs that help protect the livelihood of over 47,000 Ontario farmers against the many risks farm businesses face every day. Our employees are skilled professionals who respond when industry and government need us, manage public funds with great care and integrity, and deliver a quality customer experience. Agricorp helps grow Ontario agriculture. We underwrite $6-8 billion in risk each year. The agency was established in 1997, and since then we’ve made over $8 billion in payments to farmers when they needed it most. Please advise if you require accommodation during the recruitment process. We thank all applicants for their interest; however, only those selected for an interview will be contacted directly.

Canada
C$34 / hour
CorVel Corporation logo

Claims Specialist

CorVel Corporation

Raising the bar for care. Lowering risk for clients.

Full TimeRemoteTeam 1,001-5,000Since 1987H1B Sponsor

• Receives Workers’ Compensation claims, confirms policy coverage and acknowledgment of the claim • Determines validity and compensability of the claim • Establishes reserves and authorizes payments within reserving authority limits • Manages non-complex lost-time workers’ compensation claims under close supervision • Communicates claim status with the customer, claimant and client • Adheres to client and carrier guidelines and participates in claims review as needed • Assists other claims professionals with more complex or problematic claims as necessary • Additional projects and duties as assigned

New York
$53.0K - $85.5K / year
Crawford & Company logo

Leave Specialist

Crawford & Company

We’re Crawford, a global leader in claims management, where every claim represents a person and a community we help restore. At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values.

Full TimeRemoteTeam 10,001

Role Description As a Leave Specialist, you’ll administer FMLA policies for multiple clients, manage leave requests, and ensure compliance while providing exceptional support. If you’re detail-oriented and thrive in a fast-paced environment, this is your chance to join a team that values flexibility and excellence. Qualifications - Detail-oriented - Ability to thrive in a fast-paced environment Requirements - Experience administering FMLA policies - Strong management of leave requests - Ensuring compliance with relevant regulations Benefits - Pay and incentive plans that recognize performance excellence - Benefit programs that empower financial, physical, and mental wellness - Training programs that promote continuous learning and career progression while enhancing job performance - Sustainability programs that give back to the communities in which we live and work - A culture of respect, collaboration, entrepreneurial spirit, and inclusion

Worldwide