Davies North America

Global insurance professional services and tech

Workers' Compensation Adjuster

Claims AdjudicationUpdated on Nov 13

Full-timeRemote in USA$65k - $75k /yr

About the Job

Requirements

At least 3 years of Workers’ Compensation claims-handling experience.
Active adjuster licenses as required by Louisiana, or the ability to obtain them.
Direct experience handling Louisiana Workers’ Compensation claims, depending on level.
Knowledge of Louisiana 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 accurately.
Conduct detailed investigations, including interviews and evidence gathering.
Analyze medical, legal, and employment documentation to guide decisions.
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.
Handle catastrophic and high-severity claims.
Use preferred vendors and cost-containment tools effectively.
Deliver clear reporting to clients and excess carriers.
Maintain client relationships through responsive, professional communication.
Stay current on jurisdictional requirements, trends, and best practices.
Support team development through mentorship and knowledge sharing.
Independently handle moderate-complexity Workers’ Compensation claims, including medical-only and lost-time files.
Conduct investigations, determine compensability, evaluate exposure, and establish appropriate reserves.
Manage claim strategy, medical and legal developments, and resolution planning with increasing independence.
Handle some litigated matters and exercise sound judgment in negotiations, reserving, and file direction.
Maintain compliance with jurisdictional requirements and client service expectations.

Desired Qualifications

Experience with lost-time claims, compensability analysis, and claim strategy.

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
We are seeking a Louisiana Workers’ Compensation Claims Adjuster to investigate, evaluate, and manage Workers’ Compensation claims while delivering timely, cost-effective resolutions and exceptional client service. This role manages claims of increasing complexity based on level, including moderate to complex losses, litigated matters, and catastrophic exposures. The adjuster develops and executes strategic action plans to ensure claims are resolved appropriately, efficiently, and in compliance with jurisdictional requirements.

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
Independently handles Workers’ Compensation claims of moderate complexity, including
medical-only and lost time files
Conducts investigations, determines compensability, evaluates exposure, and establishes
appropriate reserves
Manages claim strategy, medical and legal developments, and resolution planning with
increasing independence
Handles some litigated matters and applies sound judgment in negotiations, reserving, and
file direction
Maintains compliance with jurisdictional requirements and client service expectations

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 Louisiana (or ability to obtain)
Direct experience handling Louisiana Workers’ Compensation claims (level‑dependent)
Knowledge of Louisiana 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

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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