Remote Pip Claims Adjuster Jobs in Rio Rancho, NM

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
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.
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

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 NoticeIt 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