Senior WC Claim Adjuster

Senior WC Claim Adjuster
Department: Claims Administration & Adjusting
Employment Type: Permanent - Full Time
Location: Home United States
Reporting To: Shirley Smith-Chavis
Compensation: $80,000 - $85,000 / 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're on the lookout for a Senior Workers’ Compensation Adjuster to join our growing team in Florida! As a Senior Workers’ Compensation Adjuster, you will investigate assigned Florida Workers’ Compensation claims, evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim while setting appropriate reserves. You will also provide benefits and initiate state filings promptly while exercising discretion and independent judgement. 

Key Responsibilities

Evaluate claim detail, including Florida Statute and case law, to determine compensability and total value of the claim; set and adjust reserve accordingly

Initiate investigation and assign defense counsel when appropriate

Initiate accurate indemnity payments in a timely manner and maintain diary for ongoing payments

Timely proper completion of State filings

Handle EDI filings and rejections in conjunction with EDI adjuster

Monitor medical treatment in conjunction with assigned Nurse Case Manager

Review, document, and approve medical bills for payment within three days of receipt

Authorize appropriate medical services as outlined per Florida Statute 440.13

Determine whether vocational rehabilitation services are needed for an employee to return to work

Coordinate light duty availability and reasonable accommodations with medical providers and employers

Maintain adequate reserves for life of claim utilizing reserve worksheets, ODG Guidelines, Workers’ Computation software and Davies Claims North America reserving philosophy

Attend client meetings as necessary, and maintain regular telephone contact to ensure client satisfaction

Maintain diary and workflow requirements

Maintain working knowledge of FL Workers’ Compensation Statutes and Rules, and their application

Direct defense counsel in handling of litigation claims with defense input, make timely decisions regarding litigated issues

Protect Medicare’s interest in conjunction with MMSEA Section 111 Reporting requirements

Review claims for possible red flags

Demonstrate capability of identifying and pursuing subrogation, contribution, indemnification, or other opportunities to compel responsible third parties to bear their share of the settlement burden

Request reimbursement at least quarterly and follow up for timely receipt from excess carrier(s)

Adhere to client profile instructions

Report any overall account or client concerns to the supervisor or upper management

Report any E&O concerns to the QA Manager and Executive Vice President

Maintain 97% claim closure ratio

Skills, knowledge & expertise

College degree

Multiple years’ experience handling several types of claims 

Presumption claims handling experience

Experience with depositions, mediations, and litigation

Experience with IDatix, Reference Books-Periodicals, Workers Computation, ISO, ShoreTel 

3-5 years of Lost Time/Legal claims handling experience; preferred 5+ years 

Possess FL-All Lines Adjuster or Workers’ Compensation License and maintain CEU credits for license

Previous experience with settling claims 

Experience with Microsoft Office Suite

Proactive, independent, and takes initiative with consistent follow through 

Superb communication skills, verbal and written, conducted in a timely manner

Superior time management skills with capability of working with and meeting deadlines 

Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment

Excellent team player with interpersonal skills 

High level attention to detail and problem-solving skills 

Capable of working collaboratively and independently with minimal supervision 

Exhibit discretion with sensitive and confidential information 

Display a comfort level working with key people at all levels within an organization 

Equal Employment Opportunity & Legal Notices
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 support your health and that of your family

A 401(k) plan with employer matching

Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees

Paid holidays

Life insurance and short‑term and long‑term disability coverage

Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee’s primary work location.

Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.

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.

Background Check & Fair Chance Compliance 

Any background check or review of criminal history, if applicable to the role, will be conducted only after a conditional offer of employment and in compliance with applicable federal, state, and local laws, including fair‑chance hiring requirements.

Massachusetts Notice
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

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 recruitment@davies-group.com