Sr. Work Comp Claims Adjuster (Texas)

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

DUTIES AND RESPONSIBILITIES:

• Effectively manages a caseload of 110 to 130 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.

QUALIFICATIONS REQUIRED:

Education/Experience:  High School Diploma or GED required. Bachelor’s degree in related field (preferred); ideally five 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 independently and effectively manage very complex claims.

Other Qualifications: 

• Texas Workers Compensation License or Texas All Lines License