Workers’ Compensation Medical Only Claims Adjuster | Remote
About The Position
Our client is seeking a Workers’ Compensation Medical Only Claims Adjuster to join their Texas team. This person will oversee and manage medical-only workers’ compensation claims, ensuring timely evaluations, appropriate medical care, and efficient claim resolutions. This is an excellent opportunity for a claims professional who enjoys investigating workplace injuries, working closely with medical providers, and managing claims from initial reporting through closure. The ideal candidate will have a strong understanding of workers’ compensation regulations, medical billing practices, and claims administration.
Requirements
- 1-3 years of workers' compensation medical only or claims associate experience.
- Active Texas adjusters license
- Understanding of workers’ compensation laws, medical terminology, and applicable state regulations.
- Familiarity with medical billing, treatment coordination, compensability determinations, and claim reserving.
- Ability to evaluate medical records, investigate claims, and identify potential changes in claim exposure.
Nice To Haves
- Experience managing medical-only workers’ compensation claims preferred.
Responsibilities
- Handle a caseload of medical-only workers’ compensation claims involving exposures up to $10,000.
- Investigate reported workplace injuries, gather supporting documentation, and evaluate claim eligibility.
- Review claim details to make appropriate compensability decisions in accordance with applicable workers’ compensation regulations.
- Oversee medical treatment activities, review provider invoices, and approve services within established authorization limits.
- Maintain regular communication with injured employees, employers, healthcare professionals, and other involved parties.
- Establish and update claim reserves based on medical expenses, claim developments, and anticipated exposure.
Benefits
- Competitive Medical, Dental and Vision plans
- Employer match 401(k)
- Paid Holidays & Paid Time off
- Advancement opportunities internally within the organization
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
