Workers Compensation Claims Adjuster

INSURICA, Inc • TX

95d

About The Position

The Worker’s Compensation Claims Adjuster will manage a caseload of approximately 150 open claims, exercising good judgment while resolving claims according to our established procedures and best claims practices, in accordance with statutory, regulatory, and ethical requirements.

Requirements

• 2 – 5 Years of previous workers’ compensation claims handling experience preferred
• Possession of a current Texas Workers’ Compensation Adjuster License or an All-Lines Adjuster License is required
• Strong judgment and decision-making skills, with the ability to effectively analyze claims exposure to determine the proper course of action
• Extensive knowledge of Workers’ Compensation law, industry standards, and medical and legal terminology
• Strong working knowledge of the Texas Workers’ Compensation Act, including specific rules and case law
• Strong working knowledge of various medical services normally provided to injured workers
• Knowledge of EDI (Reporting requirements for the State of Texas)
• Excellent organizational skills, demonstrating attention to detail, accuracy, and the ability to meet deadlines
• Ability to work within a fast-paced, changing-priority environment
• Self-motivated, with the initiative to prioritize and be self-directed
• Ability to communicate effectively, both verbally and in writing
• Excellent interpersonal skills, with the ability to interact effectively with both colleagues and managers, across all levels
• Ability to promote and maintain a team environment, willing to find accommodating solutions for our customers, companies, and the Agency
• Ability to successfully adhere to company policies and procedures, as well as maintain strict confidentiality

Nice To Haves

• Spanish language skills (speak and understand) preferred, but not required

Responsibilities

• Receive and review initial workers’ compensation claims, verifying the accuracy and completeness of claim forms and supporting documentation
• Conduct thorough investigations to determine validity and extent of injury; interview the injured employee, employer(s), and any witnesses, as well as review medical reports, and accident reports to determine causality, and compensability
• Effectively communicate with the injured worker, employer(s), medical professionals, and legal representatives, as needed, providing ongoing updates and information to all parties involved in the claim process
• Make appropriate determinations on the approval, or denial, of claims, based on investigation findings and applicable laws; calculate correct benefit amounts, including medical expenses, wage replacement, and any other necessary compensation
• Manage and monitor open claims to ensure timely and appropriate processing; coordinate return-to-work programs and rehabilitation services
• Effectively maintain detailed and accurate records for each claim; prepare and submit required documentation and reports to regulatory bodies and insurance companies
• Timely initiate, maintain, and terminate temporary, impairment, and supplemental income benefits
• Identify and pursue subrogation, when there is 3rd party negligence, and negotiate fair settlement for all parties involved
• Address and resolve any disputes or issues that arise during the claim process
• Review all activities relating to the public, customers, and companies to avoid issues involving potential errors and omissions and ensure compliance with workers’ compensation laws and regulations
• Participate in seminars and other training to maintain required licenses and for knowledge and skill development

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees