Medical Only Adjuster
Permanent - Full Time $44,000 - $52,000 / yearJob Overview
Our Story
Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.
Davies is seeking a detail-oriented and proactive Medical Only Adjuster to manage workers’ compensation medical-only claims for assigned TPA clients. This role requires strong knowledge of Florida Workers’ Compensation statutes, independent judgment, and the ability to deliver timely, compliant, and high-quality claims handling while maintaining exceptional service standards.
Key Responsibilities
- Investigate and adjust medical-only Workers’ Compensation claims in compliance with Florida statutes and case law
- Complete timely 48-hour contacts with injured workers, employers, and medical providers
- Determine compensability, authorize medical treatment, and initiate required state and EDI filings
- Review, document, and approve medical bills within required timeframes
- Monitor medical care and coordinate return-to-work and light duty accommodations
- Establish and maintain appropriate reserves and diary/workflow compliance
- Maintain regular communication with injured workers and clients to ensure service quality
- Identify red flags, recovery opportunities, and escalate concerns as appropriate
- Meet performance standards, including claim closure and quality metrics
- Participate in required training, client meetings, and ongoing professional development
Skills, knowledge & expertise
- Working knowledge of Florida Workers’ Compensation law, rules, procedures, and case law
- Understanding of liability principles, medical terminology, and treatment protocols
- Strong organizational skills with the ability to manage multiple priorities
- Excellent written and verbal communication skills
- Ability to independently manage a medical-only caseload while meeting performance metrics
- Strong attention to detail and commitment to compliance and quality