Workers' Compensation Medical Only Adjuster (Remote)

Davies North America; United States; À distance; USD 52 000 - 55 000; Plein temps

Avantages offerts par ce poste

Health, dental, and vision plans

401(k) plan with employer matching

Paid time off and paid holidays

Life insurance and disability coverage

Résumé du poste

Davies North America is seeking a Workers' Compensation Medical Only Claims Adjuster to manage indemnity and medical-only claims from intake to resolution. You will investigate, evaluate, and adjudicate in line with client expectations and jurisdictional rules.

The role requires 3+ years WC claims experience, an active FL license, and the ability to handle multiple claims in a fast-paced environment while coordinating return-to-work and settlements.

Qualifications

• 3+ years of Workers' Compensation claims handling experience.
• Active Florida license or ability to obtain.
• Experience with medical-only, lost time, or blended WC portfolios preferred.
• Strong knowledge of WC laws, benefit structures, and claims processes.
• Experience managing indemnity payments and return-to-work programs.
• Ability to handle multiple claims in a fast-paced environment.
• Strong investigative, analytical, and decision-making skills.
• Effective negotiation and problem-solving abilities.
• Excellent written and verbal communication skills.
• Proficiency with claims management systems and related technology.
• Active adjuster license(s) or ability to obtain as required.

Responsabilités

• Own Workers' Compensation claims from intake through closure.
• Determine compensability and benefit eligibility.
• Establish and adjust reserves based on claim exposure.
• Conduct investigations, including interviews and documentation review.
• Develop and execute claim strategies.
• Identify opportunities for early resolution.
• Monitor treatment plans and coordinate return-to-work efforts.
• Administer indemnity benefits in compliance with jurisdictional requirements.
• Coordinate with defense counsel on litigated claims.
• Support hearings, mediations, and settlements.
• Provide timely updates to clients and stakeholders.
• Ensure compliance with state regulations and internal standards.
• Maintain regular attendance and be available during work hours.

Connaissances

WC claims handling

Investigation & case management

Negotiation

Communication skills

Medical knowledge

Claims management systems

Active adjuster license

Outils

Claims management systems

Description du poste

Department: Claims Administration & Adjusting

Location: Home United States

Compensation: $52,000 - $55,000 / year

Description

Our Story

Imagine being part of a team that is 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.

What's in Store

At Davies North America, we're focused on delivering smart, efficient claims solutions that make a real impact for our clients. We're seeking a Workers' Compensation Medical Only Claims Adjuster who brings strong technical expertise, sound judgment, and a proactive approach to managing indemnity and medical-only claims.

This role manages Workers' Compensation claims from intake through resolution and may support medical-onlyclaim types depending on the assigned client program. The adjuster investigates, evaluates, and manages claims in accordance with company guidelines, client expectations, and jurisdictional requirements.

Key Responsibilities

Claim Ownership & Adjudication

• Manage Workers' Compensation claims from intake through closure
• Determine compensability and benefit eligibility
• Establish and adjust reserves based on claim exposure

Investigation & Case Management

• Conduct investigations, including interviews and documentation review
• Develop and execute claim strategies
• Identify opportunities for early resolution

Medical & Indemnity Management

• Monitor treatment plans and coordinate return-to-work efforts
• Administer indemnity benefits in compliance with jurisdictional requirements

Litigation Management

• Coordinate with defense counsel on litigated claims
• Support hearings, mediations, and settlements
• Client Communication & Compliance
• Provide timely updates to clients and stakeholders
• Ensure compliance with all state regulations and internal standards

Skills, knowledge & expertise

• 3+ years of Workers' Compensation claims handling experience
• Active FL license
• Experience with medical-only, lost time, or blended Workers' Compensation claim portfolios preferred
• Strong knowledge of Workers' Compensation laws, benefit structures, and claims processes
• Experience managing indemnity payments and return-to-work programs
• Ability to handle multiple claims in a fast-paced environment
• Strong investigative, analytical, and decision‑making skills
• Effective negotiation and problem‑solving abilities
• Excellent written and verbal communication skills
• Proficiency with claims management systems and related technology
• Active adjuster license(s) or ability to obtain as required

Preferred

• Multi‑state claims handling experience
• Experience with EDI reporting and jurisdictional compliance requirements
• Familiarity with nurse case management and medical cost containment strategies

Equal Employment Opportunity & Legal Notices

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

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.

Essential Functions

• Maintain regular and dependable attendance.
• Be available and able to perform job responsibilities during established work hours.

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]