Senior Workers' Compensation Claims Adjuster - New Mexico

Department: Claims Administration & Adjusting

Employment Type: Permanent - Full Time

Location: Remote, NM

Reporting To: Kimberly Jordan Binkley

Compensation: $85,000 - $92,000 / year

Description

The Senior Workers' Compensation Claims Adjuster is responsible for investigating, evaluating, and managing workers' compensation claims from inception to resolution. This role requires independent decision-making, strong analytical skills, and the ability to develop and execute strategic claim plans to ensure timely and appropriate outcomes. The position handles complex claims, including litigation and catastrophic losses, while delivering exceptional service to clients and stakeholders.

This is a hybrid position, requiring candidates to reside in New Mexico and support in-office work as needed, in addition to remote responsibilities.

Key Responsibilities

• Investigate and evaluate claims to determine coverage, compensability, and liability
• Conduct thorough investigations, including interviews with claimants, employers, and witnesses
• Obtain and review relevant documentation (e.g., medical records, police reports, employment records)
• Develop and implement strategic action plans for claim resolution
• Prepare and present clear, accurate, and timely reports to clients and carriers
• Manage EDI reporting and CMS/Section 111 compliance requirements
• Negotiate settlements with claimants and legal representatives to achieve fair resolutions
• Oversee litigation activities, ensuring effective cost control and alignment with account requirements
• Utilize approved vendor partners to support claims handling activities
• Handle complex claims, including catastrophic losses and sensitive issues
• Respond promptly and professionally to client inquiries and communications
• Maintain compliance with all licensing and regulatory requirements
• Stay current with industry trends, legal updates, and best practices through ongoing training
• Support team development by mentoring and sharing expertise with colleagues, as needed
• Perform other duties as assigned

Skills, knowledge & expertise

• Active New Mexico Adjuster License (required)
• 5-7 years of experience handling workers' compensation claims, including complex files
• Bachelor's degree or equivalent combination of education and professional experience
• Proven experience handling litigation and complex claim scenarios preferred
• Strong understanding of workers' compensation claims handling principles and practices
• Knowledge of medical terminology and legal concepts, including litigation management
• Ability to conduct detailed investigations in multi-party environments
• Excellent analytical and problem-solving skills with strong attention to detail
• Ability to manage multiple priorities and meet time-sensitive deadlines
• Proficiency with claims management systems and standard business software
• Strong written and verbal communication skills, including report writing and presentations
• Ability to maintain confidentiality and exercise sound judgment
• Ability to quickly learn and adapt to evolving processes, regulations, and technology
• Working knowledge of multi-state laws and regulations is a plus
• Ability to work both independently and collaboratively in a hybrid work environment

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.

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]