Workers' Comp Medical Only Adjuster

Davies Group; Northern (KY); Hybrid; USD 50,000 - 55,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

401(k)

Paid time off

Holidays

Life insurance

Disability

Job summary

Davies North America is seeking an experienced Workers' Comp Medical Only Adjuster to investigate, evaluate, and manage medical-only workers’ compensation claims from a home-based environment in the United States. The role requires strong knowledge of Florida statutes, medical terminology, and proactive claims handling to meet client expectations.

Key responsibilities include reserving, bill review, coordination with providers and return-to-work efforts, and client communication.

Qualifications

• Extensive experience handling workers’ compensation medical-only claims.
• Knowledge of Florida workers’ compensation statutes.
• Strong written and verbal communication and documentation skills.
• Proficiency with claims management systems and MS Office.
• Ability to evaluate compensability, reserves, and benefit entitlement.

Responsibilities

• Investigate and manage assigned workers’ compensation medical-only claims.
• Evaluate claim details, statutes, case law, and medical information for compensability.
• Set reserves and monitor the life of the claim using standard tools and guidelines.
• Provide benefits and initiate required state filings.
• Monitor medical treatment and coordinate with Nurse Case Managers.

Skills

W/C claims experience

Strong communication

Case investigation

Reserving skills

Subrogation knowledge

Client meetings experience

Microsoft Office

Tools

Claims management systems

ISO knowledge

Medical bill review tools

Microsoft Office Suite

Job description

Workers' Comp Medical Only Adjuster

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Home United States

Reporting To: Brenda Goff

Compensation: $49,500 - $55,000 / year

Description

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 North America is seeking an experienced Medical Only Adjuster to join our claims team. This position is responsible for investigating, evaluating, and managing assigned workers’ compensation medical-only claims in accordance with company standards, client expectations, and applicable state regulations.

The ideal candidate will have a strong understanding of workers’ compensation claims handling, Florida workers’ compensation statutes, medical terminology, claim investigation, reserving, and return-to-work coordination. This role requires sound judgment, strong communication skills, and the ability to manage claims proactively while delivering excellent service to injured workers, employers, clients, and medical providers.

Key Responsibilities

• Investigate assigned workers’ compensation claims by completing timely contact with injured workers, employers, physicians, witnesses, and other involved parties.
• Evaluate claim details, applicable statutes, case law, and medical information to determine compensability and claim value.
• Set and maintain appropriate reserves for the life of the claim using applicable tools, guidelines, and company reserving practices.
• Provide benefits and initiate required state filings in a timely and accurate manner.
• Monitor medical treatment in coordination with Nurse Case Managers when assigned.
• Review, document, and approve medical bills for payment within required timeframes.
• Authorize appropriate medical services in accordance with applicable workers’ compensation statutes and claim requirements.
• Maintain regular contact with injured employees to support claim progression and customer service.
• Coordinate light duty availability and reasonable accommodations with employers and medical providers.
• Review assigned impairment ratings for accuracy and take appropriate action, including transferring claims or initiating impairment benefits and filings when required.
• Maintain claim diaries, workflow requirements, and accurate file documentation.
• Review claims for potential red flags, compensability concerns, and escalation needs.
• Identify and pursue subrogation, contribution, indemnification, or other recovery opportunities when applicable.
• Adhere to client-specific claim handling instructions and service expectations.
• Attend client meetings as needed and maintain regular communication to support client satisfaction.
• Negotiate claim settlements when appropriate.
• Make timely notice to excess carriers when claims meet reporting criteria and provide ongoing updates as needed.
• Maintain required continuing education credits and licensing requirements.
• Report account, client, E&O, or quality concerns to appropriate management.
• Maintain a positive, team-oriented approach while delivering high-quality service to clients and claimants.
• Perform other duties as assigned by claims leadership.

Skills, knowledge & expertise

• Prior experience handling workers’ compensation claims.
• Working knowledge of workers’ compensation laws, rules, procedures, and claim handling practices.
• Familiarity with Florida Workers’ Compensation Statute and related claim requirements preferred.
• Strong understanding of medical terminology, medical procedures, and treatment documentation.
• Ability to evaluate compensability, claim exposure, reserves, and benefit entitlement.
• Strong written and verbal communication skills.
• Excellent organizational skills with the ability to manage diaries, deadlines, and workflow requirements.
• Ability to exercise discretion, independent judgment, and sound decision-making.
• Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook.
• Ability to learn and effectively use claims management systems and related business software.
• Florida workers’ compensation claims handling experience.
• Experience handling medical-only workers’ compensation claims.
• Prior TPA experience.
• Experience with claim systems, medical bill review, ISO, and workers’ compensation reserving tools.
• Knowledge of subrogation, contribution, indemnification, and excess carrier reporting.
• Experience participating in client meetings or claim reviews.

Benefits

At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:

• 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

Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location.

Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.

Diversity and Inclusion

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.

Compensation Transparency

The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.

Background Check & Fair Chance Compliance

Any background check or review of criminal history, if applicable to the role, will be conducted only after a conditional offer of employment and in compliance with applicable federal, state, and local laws, including fair‑chance hiring requirements.

Massachusetts Notice

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

AI Policy

At Davies, we value authentic conversations and a fair candidate experience. While candidates may use AI and technology tools to prepare for interviews, we expect interview responses and assessments to reflect each individual's own experience, knowledge, and professional judgment.

We do not use sites like Facebook, Craigslist, or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal, please email us at [e-mail]