Davies North America

Global insurance professional services and tech

Workers' Compensation Adjuster

Claims AdjudicationUpdated on Nov 13

Full-timeNew Mexico, USA$85k - $92k /yr

About the Job

Requirements

Must live in New Mexico and hold a New Mexico adjuster license.
Must have at least 5 years of experience handling Workers' Compensation claims.
Must understand and follow oral or written policies, procedures, and instructions.
Must perform a wide variety of duties accurately and quickly while meeting time-sensitive deadlines.
Must be able to conduct investigations in multi-party situations.
Must be able to use standard or customized software applications appropriate to assigned tasks.
Must be able to prepare and present accurate, reliable, factual reports with recommendations.
Must have thorough knowledge of current claims investigation, adjustment, and related practices.
Must have extensive knowledge of medical and legal terminology and a thorough understanding of legal principles and litigation management.
Must be able to handle confidential information.
Must be able to communicate effectively orally and in writing.
Must be willing and able to learn quickly and use new skills as information or technology changes rapidly.
Must be able to comprehend multi-state laws and regulations to assist other offices as necessary.
Must maintain and meet specific licensing requirements.

Responsibilities

Determine insurance coverage and compensability for each filed claim.
Investigate claims, including interviewing employees, employers, and witnesses.
Obtain necessary records, including hospital, police, and physician records.
Complete EDI and CMS/Section 111 reporting.
Use appropriate preferred vendors.
Present thorough and accurate reports to clients or carriers about claim investigations and situations.
Negotiate settlements with claimants and their attorneys.
Control litigation activities and costs according to account requirements.
May mentor, train, or share expertise with other Davies staff.
Attend meetings, conferences, workshops, or training sessions and review written material to maintain current knowledge of principles, practices, and developments in assigned work areas.
Respond to client questions and comments courteously and promptly.
Handle catastrophic losses, complex litigation, and other sensitive issues.
Perform other duties as assigned.

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 on the lookout for an experienced Workers' Compensation Adjuster to join our team. You will be responsible for investigating and evaluating losses while developing a plan of action to bring claims to proper resolution in a timely manner.
This role does require you to live in New Mexico and have New Mexico adjuster license, with a minimum of 5-7 years of experience handling Workers' Compensation claims.

Determines extent of insurance coverage and compensability on each filed claim
Investigates claims, including interviewing employees, employers and witnesses
Obtains necessary records, including but not limited to, hospital records, police reports, physician records, etc.
EDI and CMS/Section 111 reporting
Utilizes appropriate preferred vendors
Presents thorough and accurate reports to client and/or carrier on claims investigations/situations
Negotiates settlements for resolutions with claimants and their attorneys
Maintains control of litigation activities and costs per account requirements
May be asked to mentor, train and/or share expertise with other Davies staff
Attends meetings; conferences; workshops or training sessions; and reviews written material to maintain current knowledge on principles, practices and new developments in assigned work areas
Maintains and meets specific licensing requirements
Responds to client questions and comments in a courteous and timely manner
Is responsible for catastrophic losses, complex litigation, and other sensitive issues
All other duties as assigned

Ability to understand and follow oral and/or written policies, procedures and instructions
Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
Ability to conduct investigations in multi-party situations
Ability to use standard or customized software applications appropriate to assigned tasks
Ability to prepare and present accurate, reliable and factual reports with recommendations
Thorough knowledge of current principles and practices associated with claims investigations, adjustment and related practices
Extensive knowledge of medical and legal terminology with a thorough understanding of Legal principles/litigation management
Ability to handle confidential information
Ability to communicate effectively with others both orally and in writing
Ability and willingness to learn quickly and utilize new skills because of rapidly changing information and/or technology
Ability to comprehend multi-state laws and regulations to assist other offices, as necessary

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

Recently Posted Jobs

Explore more opportunities at Davies North America

See more jobs