Workers Compensation Claims Examiner

Senior Workers’ Compensation Claims Examiner (Texas Licensed)

We are seeking an experienced Workers’ Compensation Claims Examiner to join a collaborative claims team handling complex indemnity claims from initial investigation through resolution. This is an excellent opportunity for a detail-oriented professional who thrives in a fast-paced environment and enjoys balancing analytical decision-making with strong client and claimant communication.

In this role, you will independently manage a caseload of approximately 110–150 workers’ compensation claims, including complex files requiring advanced investigation, compensability analysis, reserve management, and ongoing medical oversight. You will work closely with claimants, employers, medical providers, attorneys, and internal stakeholders to ensure timely and compliant claim resolution in accordance with Texas workers’ compensation regulations.

Key Responsibilities:

• Investigate and manage workers’ compensation claims from inception to closure

• Determine compensability and administer benefits in accordance with state laws and company guidelines

• Coordinate medical treatment and manage related billing activity

• Establish and maintain accurate claim reserves

• Maintain organized documentation and diary management for all claim activity

• Communicate effectively with clients regarding claim status, trends, and risk concerns

• Conduct independent file reviews and proactively drive claims toward resolution

Qualifications:

• Active Texas Workers’ Compensation Adjuster License required

• 5+ years of workers’ compensation claims handling experience, including complex indemnity claims

• Strong understanding of workers’ compensation statutes, medical terminology, and claims investigation

• Excellent written and verbal communication skills

• Ability to manage a high-volume caseload independently

• Proficiency with Microsoft Office applications preferred

This position offers the opportunity to join a professional, team-oriented environment where your expertise and judgment will have a direct impact on claim outcomes and client satisfaction.