Sr. Claims Adjuster

3 days ago

Addison, Texas, United States Elite Full time $60,000 - $120,000 per year
Must have TEXAS workers' compensation license and seeking 5 years experience in lost time work comp claims for TEXAS jurisdiction.

POSITION SUMMARY:  Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.  

DUTIES AND RESPONSIBILITIES:
  • Effectively manages a caseload of 110 to 160 workers' compensation files, including very complex claims.*
  • Initiates and conducts investigation in a timely manner.*
  • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.*
  • Manages medical treatment and medical billing, authorizing as appropriate.*
  • Communicates with claimants, providers and vendors regarding claims issues.*
  • Computes and set reserves within Company guidelines. 
  • Maintains diary system for case review and documents file to reflect the status and work being performed on the file.*
  • Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.*
  • Adheres to all Company policies and procedures.*
  • Conducts file reviews independently.*
  • Other duties as assigned.
* Essential job function.

EQUIPMENT OPERATED/USED:  Computer, 10-key, fax machine, copier, printer, and other office equipment.

QUALIFICATIONS REQUIRED:

Education/Experience:  High School Diploma or GED required. Bachelor's degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience. 

Knowledge, Skills and Abilities:
  • Technical knowledge of statutory regulations and medical terminology.
  • Analytical skills.
  • Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
  • Ability to interact with persons at all levels in the business environment.
  • Ability to independently and effectively manage very complex claims.
  • Proficient in Word and Excel (preferred).
Other Qualifications:  
  • Texas Workers Compensation License

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