Job Description

Senior TX Workers’ Compensation Claims Adjuster

Summary
Our client is a growing Third-Party Administrator (TPA) dedicated to providing exceptional claims management services to self-insured employers, insurance carriers, and public entities. Our team is committed to delivering timely, accurate, and customer-focused claims handling while maintaining compliance with all applicable regulations. We are seeking an experienced Senior Texas Workers’ Compensation Claims Adjuster to manage a caseload of Texas workers’ compensation claims from inception through closure. The ideal candidate will possess strong technical expertise, excellent communication skills, and a thorough understanding of Texas workers’ compensation laws and regulations. 

Compensation Package

• $80,000 - $100,000/year
• Medical, dental, and vision insurance
• Remote work flexibility

Responsibilities

• Investigate, evaluate, negotiate, and resolve Texas workers’ compensation claims in accordance with state statutes, client guidelines, and company best practices.
• Manage a full caseload of indemnity and medical-only claims from assignment through closure.
• Conduct timely contacts with injured employees, employers, medical providers, attorneys, and other involved parties.
• Analyze compensability, liability, medical treatment plans, wage information, and disability status.
• Establish and maintain appropriate claim reserves based on exposure and claim development.
• Authorize and coordinate medical treatment within Texas workers’ compensation guidelines.
• Monitor claim progress and proactively identify opportunities for early resolution and cost containment.
• Prepare and file required documentation with the Texas Department of Insurance, Division of Workers’ Compensation (DWC).
• Negotiate settlements and participate in mediations, benefit review conferences, and other dispute resolution proceedings as needed.
• Collaborate with nurse case managers, defense counsel, vocational rehabilitation specialists, and other vendors.
• Maintain accurate and comprehensive claim documentation within the claims management system.
• Ensure compliance with all regulatory requirements, client service standards, and internal performance metrics.
• Provide exceptional customer service while maintaining positive relationships with clients and stakeholders.

Qualifications

• Minimum of 5 years of Texas workers’ compensation claims adjusting experience.
• Strong knowledge of Texas Workers’ Compensation statutes, regulations, and claims-handling procedures.
• Active TX Adjuster's License
• Experience handling indemnity claims with varying levels of complexity.
• Ability to independently manage a caseload while meeting productivity and quality standards.
• Excellent investigative, analytical, negotiation, and decision-making skills.
• Strong written and verbal communication abilities.
• Proficiency with claims management systems and Microsoft Office applications.
• Ability to prioritize competing demands and work effectively in a fast-paced environment.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer’s discretion.

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