7 Claims Adjuster Medical Only (Workers Compensation Claims) Jobs in Houston, TX
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Claims Adjuster Medical Only (Workers Compensation Claims)
$78k-99k (estimate)
Full Time | Specialty Trade in Construction
3 Weeks Ago
ELITE is Hiring a Claims Adjuster Medical Only (Workers Compensation Claims) Near Houston, TX
POSITION: Claims Adjuster – MEDICAL ONLY Claims for Workers’ Compensation (TEXAS Jurisdiction)PAY RATE & STATUS: $21.63 - $24.51 per hour & Non-ExemptPOSITION 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 150 to 180 workers’ compensation files, including complex claims.*
- Initiates and conducts claims investigation in a timely manner.*
- Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.*
- Manages medical treatment and medical billing, authorizing as appropriate.*
- Refers cases to outside defense counsel as appropriate. Monitors legal aspects.*
- Communicates with claimants, providers, and vendors regarding claims issues.*
- Computes and sets reserves within Company guidelines. Limits are less than those allowed for Claims Adjuster III but equal to a Claims Adjuster I/Medical Only.*
- Settles and/or finalizes all claims and obtains authority as designated.*
- Maintains diary system for case review and document 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.*
- Involves COMPANY loss control staff when appropriate.*
- Adheres to all Company policies and procedures.*
- Participates in file reviews, as needed.
- Other duties as assigned.
- *Essential job function.
- 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 interact with persons at all levels in the business environment.
- Ability to independently and effectively manage very complex claims.
- Proficient in Word and Excel (preferred).
- TEXAS claims adjusters license/Certification and/or or license as required by State regulation.
Job Summary
JOB TYPE
Full Time
INDUSTRY
Specialty Trade in Construction
SALARY
$78k-99k (estimate)
POST DATE
04/07/2024
EXPIRATION DATE
06/15/2024
HEADQUARTERS
LINDEN, MI
SIZE
50 - 100
FOUNDED
2018
REVENUE
$10M - $50M
INDUSTRY
Specialty Trade in Construction
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