Senior Workers' Compensation Claims Examiner

7 days ago


Dallas, Texas, United States CCMS & Associates Full time

{"h1": "Senior Workers' Compensation Adjuster Job Description", "p": "CCMS & Associates is seeking a licensed Texas adjuster with 5 years of experience in lost time workers' compensation claims. This is a 1099 remote position with potential to convert to a team lead or supervisor upon assessment and performance evaluations.", "ul": [{"li": "High School Diploma or GED"}, {"li": "Bachelor's degree in related field (preferred); 5 or more years related experience; or equivalent combination of education and experience"}, {"li": "TEXAS All Lines Adjuster License with Continuing Education credits in workers compensation"}, {"li": "Working laptop computer, high-speed internet, Word, and Excel"}], "h2": "Responsibilities", "ul": [{"li": "Effectively manage workers' compensation files, including very complex claims"}, {"li": "Initiate and conduct investigation in a timely manner"}, {"li": "Determine compensability of claims and administer benefits, based on state law and in accordance with established company guidelines"}, {"li": "Manage medical treatment and medical billing, authorizing as appropriate"}, {"li": "Communicate with claimants, providers, and vendors regarding claim issues"}, {"li": "Compute and set reserves within company guidelines."}, {"li": "Maintain diary system for case review and document the file to reflect status and work being performed"}, {"li": "Communicate appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns"}, {"li": "Conduct file reviews independently"}, {"li": "Direct and assist representatives attending hearings or mediations"}, {"li": "Adhere to all company policies and procedures"}, {"li": "Other duties as assigned"}], "h2": "Knowledge and Skills", "ul": [{"li": "Technical knowledge of statutory regulations and medical terminology"}, {"li": "In-depth assessment and analytical skills"}, {"li": "Excellent written and verbal communication, including the ability to convey technical details to claimants, clients, and staff"}, {"li": "Ability to interact with persons at all levels in a business environment"}, {"li": "Ability to independently and effectively manage very complex claims"}, {"li": "Proficient in Word and Excel"}], "p": "All candidates must pass a full background check (void in states where prohibited).", "p": "Powered by JazzHR"}



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