Workers Compensation Claims Adjuster

Workers Compensation Claims Adjuster Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location: Home United States Reporting To: Gregory Uditis Compensation: $72,000 - $82,000 / 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. We are seeking an experienced Workers' Compensation Claim Adjuster to manage complex claims and deliver timely, cost-effective resolutions while providing exceptional client service. This adjuster investigates, evaluates, and manages Workers’ Compensation claims with moderate to high complexity, including catastrophic losses and litigated matters. This role independently develops and executes strategic action plans to ensure claims are resolved appropriately, efficiently, and in compliance with jurisdictional requirements.

Key Responsibilities

• Determine compensability and extent of coverage on assigned claims.
• Conduct thorough investigations, including interviews with employees, employers, and witnesses.
• Obtain and review medical, hospital, police, employment, and other relevant records.
• Manage EDI reporting and CMS Section 111 compliance.
• Utilize approved preferred vendors and cost-containment resources.
• Prepare comprehensive and accurate reports for clients and excess carriers.
• Negotiate settlements with claimants and/or their attorneys.
• Manage litigation strategy, legal vendors, and associated costs in accordance with account requirements.
• Handle catastrophic losses, complex litigation files, and other sensitive matters.
• Respond to client inquiries promptly and professionally.
• Maintain required adjuster licensing and continuing education.
• Stay current on jurisdictional regulations, industry trends, and best practices.
• Mentor, train, and share technical expertise with team members as needed.
• Perform additional duties as assigned.

Skills, knowledge & expertise

• Active adjuster licenses as required by jurisdiction.
• West Virginia Workers’ Compensation jurisdictional knowledge and handling experience.
• Workers’ Compensation claims handling experience.
• Strong knowledge of Workers’ Compensation laws, claims adjudication, and investigation practices.
• Extensive understanding of medical and legal terminology.
• Experience managing litigation and working with defense counsel.
• Ability to handle multi-party investigations and complex claim scenarios.
• Strong negotiation and settlement skills.
• Proficiency with claims management systems and related software applications.
• Ability to prepare clear, factual, and well-supported reports with recommendations.
• Excellent written and verbal communication skills.
• Strong organizational skills with the ability to meet time-sensitive deadlines.
• Ability to manage confidential information with discretion.
• Capacity to quickly adapt to evolving regulations and technology.
• Ability to interpret and apply multi-state laws and regulations.

Benefits

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 ensure your health and that of your family.
• A 401k plan with employer matching to help you build a secure financial future.
• Our time-off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
• Paid holidays.
• Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.

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. 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 [email protected] Apply tot his job Apply To this Job