Workers' Compensation Medical Only Adjuster (Remote)

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

- 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