Job Description
POSITION: Sr. WC Claims Adjuster - Workers’ Compensation (TEXAS Jurisdiction)
Hybrid: Two (2) days in-office and three (3) days work from home
REQUIRED: Texas Workers Compensation License (valid and current)
STATUS: Exempt
POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Adjusters, and other company staff.
DUTIES AND RESPONSIBILITIES:
· Effectively manages a caseload of 110 (+/-) workers’ compensation files, but caseload can fluctuate, 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.
QUALIFICATIONS REQUIRED:
Education/Experience: High School Diploma or GED required. Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.
Knowledge, Skills and Abilities:
Other Qualifications:
Company Description
Recruitment (Direct Hire Placement) and Staffing Services Company
Recruitment (Direct Hire Placement) and Staffing Services Company
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