Senior WC Claim Adjuster

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🦀 Maryland – Remote

🦀 Maryland – Remote

💵 $80k - $85k / year

⏰ Full Time

🟠 Senior

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MDD Forensic Accountants

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1933

💸 Finance

Finance • Insurance • Consulting

MDD Forensic Accountants is a forensic accounting firm specializing in business valuations, shareholder disputes, and economic damage quantification. With over 40 offices globally, MDD provides expertise across a wide range of industries, delivering services to insurance companies, law firms, governments, and individuals. Their services include business interruption, lost profits, fraud investigations, and more, making them a trusted advisor for sound financial decision-making.

📋 Description

• 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 • Timely proper completion of State filings • 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

🎯 Requirements

• Must reside within the state of Maryland • Multiple years’ experience handling several types of claims • Presumption claims handling experience • Experience with depositions, mediations, and litigation • Experience with IDatix, Reference Books-Periodicals, Workers Computation, ISO, ShoreTel • 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

🏖️ 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