Sr. Adjuster-Workers Comp Claims

CopperPoint Insurance Companies•, TX

1d•Remote

About The Position

CopperPoint is hiring a fully remote Claims Adjuster Senior, Indemnity. The role requires Texas workers’ compensation jurisdiction knowledge, and the successful candidate must reside in Texas. Knowledge of Oklahoma and other surrounding Southwest state jurisdictions is preferred. The Claims Adjuster Senior analyzes time-loss workers’ compensation claims to determine compensability and adjudicates claims to ensure timely payment of indemnity and medical benefits in accordance with company standards and regulatory requirements. The role establishes and maintains action plans and reserves to support proactive, cost-effective claim management, and manages claims through resolution, including settlement negotiations, dispute resolution, and testimony at hearings when necessary.

Requirements

At least 3 years of direct handling of Texas workers’ compensation claims.
Texas Adjusters license.
Strong technical claims knowledge and prior successful experience in workers’ compensation and other commercial-lines claims management.
Knowledge of Department of Insurance (DOI), NCCI, and Department of Labor and Employment (CDLE) rules and regulations.
Ability to analyze, interpret, and apply workers’ compensation laws, rules, and regulations.
Ability to stay current with statutory and industry rule and regulatory changes, as well as company policies and procedures affecting claims management.
Ability to set priorities, manage time, organize work, and meet deadlines.
Excellent customer service skills, including initiative, mature judgment, and discretion.

Nice To Haves

Bachelor’s degree in business administration, communications, or a related field from an accredited four-year college or university.
Experience handling claims in one or more of Arizona, Utah, Nevada, New Mexico, Oklahoma, Missouri, Kansas, Florida, Georgia, North Carolina, or South Carolina.
Bilingual Spanish.

Responsibilities

Analyze and investigate indemnity claims to determine compensability by interpreting and applying workers’ compensation laws, rules, and regulations, using available resources as appropriate.
Build and maintain professional relationships with injured workers, policyholders, brokers, and agents through proactive claim management and timely communication.
Document communications and claim-management activities appropriately.
Develop, maintain, and adhere to action plans and reserves while proactively managing indemnity claims to resolution.
Maintain cost drivers and data elements to support accurate NCCI and Medicare reporting.
Manage claims in accordance with company standards and statutory requirements.
Ensure timely payment of indemnity and medical benefits and use available cost-containment measures and programs.
Identify settlement opportunities.
Negotiate settlements with claimants and attorneys.
Conduct dispute resolution with claimants and attorneys.
Testify at hearings when necessary.

Benefits

Medical insurance
Dental insurance
Vision insurance
Short-term disability coverage
Long-term disability coverage
Life insurance, including Basic Life Insurance and AD&D at two times an employee’s annual salary at no cost to the employee
Health savings account
Flexible spending account
401(k) plan with matching contributions
Employee Assistance Plan at no cost to the employee
Accrual of paid time off at 0.0769 hours per paid hour, which may total 20 days annually
10 paid holidays annually
12 hours of paid volunteer time annually
Matching of personal charitable contributions up to $500 per year
Tuition reimbursement and other education benefits
Business-casual dress