Remote Workers' Comp Lost Time Claims Adjuster

Davies Group; Northern (KY); Hybrid; USD 70,000 - 75,000; Full time

Benefits offered by this job

401(k) plan with employer matching

Medical, dental, and vision plans

Paid time off and holidays

Job summary

Davies North America is seeking a Workers’ Compensation Lost Time Claims Adjuster to investigate, evaluate, and manage workers’ compensation claims while delivering timely, cost-effective resolutions and exceptional client service. The role handles claims of increasing complexity, including moderate to complex losses, litigated matters, and catastrophic exposures.

The position involves determining compensability, performing detailed investigations, and coordinating with defense counsel to

Qualifications

• 3+ years of Workers’ Compensation claims handling experience.
• Experience with lost time claims, compensability analysis, and claim strategy preferred.
• Active adjuster licenses as required by jurisdiction (or ability to obtain).
• 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.
• Professionalism in handling sensitive or confidential information.

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 experience

Lost time claims

Licensing eligibility

Jurisdictional knowledge

Investigation & analysis

Negotiation & communication

Prioritization in fast-paced env

Claims systems proficiency

Confidentiality

Medical terminology understanding

Tools

EDI reporting

CMS compliance tools

Job description

Davies North America is seeking a Workers’ Compensation Lost Time Claims Adjuster to investigate, evaluate, and manage workers’ compensation claims while delivering timely, cost-effective resolutions and exceptional client service. The role handles claims of increasing complexity, including moderate to complex losses, litigated matters, and catastrophic exposures.

The position involves determining compensability, performing detailed investigations, and coordinating with defense counsel to