Davies North America

Global insurance professional services and tech

Workers’ Compensation Medical Only Claims Adjuster

Claims AdjudicationUpdated on Nov 13

Full-time$48k - $55k /yrRemote

About the Job

Requirements

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.
Proficiency with claims management systems and related technology.
Active adjuster license(s) or ability to obtain them as required.
An active Florida adjuster license is required.

Responsibilities

Manage 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 all state regulations and internal standards.

Desired Qualifications

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

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.

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-only, claim types depending on the assigned client program. The adjuster investigates, evaluates, and manages claims in accordance with company guidelines, client expectations, and jurisdictional requirements.

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

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
Active FL license needed

Preferred

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

About the Company

Davies North America

Global insurance professional services and tech

Davies North America is a global professional services and technology company that began in the UK as an insurance claims manager. It now provides technology, consulting, and legal solutions to clients in regulated industries, including insurance, through managed services, outsourcing, and advisory offerings. The company grows by acquiring other businesses to expand its geographic reach and service capabilities. Its goal is to become a global leader in professional services and technology for regulated industries, particularly in markets like the US, Canada, and Bermuda.

Company size: 5,001-10,000
Company stage: Debt Financing
Total funding: $363M
Headquarters: London, United Kingdom
Founded: 1968

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