Lost Time WC Claims Adjuster — Investigate & Settle

Davies; United States; Remote; USD 70,000 - 80,000; Full time

Benefits offered by this job

Medical, dental, vision

401(k) with employer match

Discretionary Time Off and PTO

Paid holidays

Disability coverage

Job summary

Davies North America is hiring a Workers’ Compensation Lost Time Adjuster to investigate, evaluate, and manage claims while delivering timely, cost-efficient resolutions and exceptional client service. This role handles complex and litigated files, ensuring compliance with jurisdictional requirements and CMS Section 111 reporting.

You will own the full lifecycle from investigation to resolution, collaborating with defense counsel to optimize outcomes and manage high-severity exposures.

Qualifications

• 3+ years of Workers’ Compensation claims handling experience.
• Experience with lost time claims, compensability analysis, and claim strategy preferred.
• Active FL license is required (5-20 or 6-20).
• Direct experience handling Workers’ Compensation claims (level-dependent).
• Knowledge of Workers’ Compensation laws and jurisdictional requirements.
• Understanding of medical terminology and its impact on claim exposure.
• Strong investigation, analysis, and decision-making skills.
• Effective negotiation and communication abilities.
• Ability to manage multiple priorities in a fast-paced environment.
• Proficiency with claims systems and related technology.

Responsibilities

• Own the full lifecycle of Workers’ Compensation claims, from initial investigation through resolution.
• Determine compensability and coverage with confidence and accuracy.
• Conduct detailed investigations, including interviews and evidence gathering.
• Analyze medical, legal, and employment documentation to guide decision-making.
• Manage EDI reporting and ensure CMS Section 111 compliance.
• Develop and execute strategic claim plans for complex and litigated files.
• Partner with defense counsel to drive effective litigation strategies and control costs.
• Negotiate settlements with claimants and attorneys to achieve optimal outcomes.
• Handle catastrophic and high-severity claims with care and precision.
• Leverage preferred vendors and cost-containment tools effectively.
• Deliver clear, insightful reporting to clients and excess carriers.
• Maintain strong client relationships through responsive, professional communication.
• Stay current on jurisdictional requirements, trends, and best practices.
• Support team development through mentorship and knowledge sharing.

Skills

Workers’ compensation claims handling

Lost time claims

Investigation and decision-making

Negotiation and settlements

Jurisdictional knowledge

Medical terminology understanding

Multi-priority management

Claims systems proficiency

Education

State FL license (5–20 or 6–20)

Job description

Davies North America is hiring a Workers’ Compensation Lost Time Adjuster to investigate, evaluate, and manage claims while delivering timely, cost-efficient resolutions and exceptional client service. This role handles complex and litigated files, ensuring compliance with jurisdictional requirements and CMS Section 111 reporting.

You will own the full lifecycle from investigation to resolution, collaborating with defense counsel to optimize outcomes and manage high-severity exposures.