Workers Compensation Claims Examiner (TEXAS Jurisdiction)
On-siteHouston, Texas, United States
Job Summary
Adjust workers' compensation claims from inception through settlement and closure, ensuring timely processing of benefits and managing medical treatment. Establish and maintain appropriate reserves, review legal correspondence and medical reports, and evaluate and approve medical procedures. Investigate coverage, liability, and monetary value of claims while negotiating settlements, liens, and rehabilitation plans. Prepare and present reports to clients, document and code claim files, and provide direction to Claims Assistants and Claims Technicians. Work collaboratively with attorneys to draft settlements and assist with litigation strategies. This fully remote Texas Jurisdiction role requires a Senior Claims Examiner with 3+ years of experience and a valid Texas 03 Workers' Compensation license. The position is available Monday-Friday at 37.5 hours a week.
Required Qualifications
- High School Diploma or equivalent (GED)
- The Texas 03 Workers' Compensation license
- 3+ years recent workers compensation claims handling experience
- Must be able to reliably commute to meetings and events as required by this position
- Ability to type quickly, accurately and for prolonged periods
- Proficient in Microsoft Office Suite
- Reasoning ability, including problem-solving and analytical skills
- Ability to be trustworthy, dependable, and team-oriented
- Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
- Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
- Maintaining honesty and integrity is essential
- Ability to learn additional computer programs
Desired Qualifications
- AA/AS or BA/BS
- The 08 All Lines License
- At least 5 years of workers compensation claims experience
- Solid knowledge of workers compensation laws, policies, and procedures
- Completion of IEA or equivalent courses
- Proficiency in determining case value and negotiating settlements
- Understanding of medical and legal terminology
- Well-developed verbal and written communication skills with strong attention to detail
- Excellent organizational skills and ability to multi-task
- Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
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