Senior Workers' Comp Lost-Time Claims Adjuster

Davies North America; United States; On-site; USD 70,000 - 75,000; Full time

Benefits offered by this job

Medical, dental, and vision

401(k) with employer match

PTO and Discretionary Time Off

Paid holidays

Life and disability insurance

Job summary

Davies North America is seeking a Workers' Compensation Lost Time Claims Adjuster to investigate, evaluate, and manage complex workers’ compensation claims, ensuring timely, cost-effective resolutions and excellent client service. The role covers full lifecycle management from initial investigation to resolution, with emphasis on compensability analysis, strategy, and litigation coordination.

The ideal candidate brings 3+ years of WC claims handling, active adjuster licensure, strong

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.

Skills

WC claims experience

Investigation

Negotiation

Jurisdiction knowledge

Medical terminology understanding

Analytical decision-making

Communication

Multi-tasking

Confidentiality

Claims systems proficiency

Tools

Claims systems

Job description

Davies North America is seeking a Workers' Compensation Lost Time Claims Adjuster to investigate, evaluate, and manage complex workers’ compensation claims, ensuring timely, cost-effective resolutions and excellent client service. The role covers full lifecycle management from initial investigation to resolution, with emphasis on compensability analysis, strategy, and litigation coordination.

The ideal candidate brings 3+ years of WC claims handling, active adjuster licensure, strong