Work Comp Claims Adjuster (Texas Jurisdiction)

POSITION SUMMARY: Under general supervision, manages workers’ compensation indemnity claims of moderate to complex difficulty from inception through resolution within assigned authority limits and established company and client guidelines. Exercises independent judgment in routine and complex claims handling and seek supervisory guidance on unusual, high-exposure, or sensitive matters.

DUTIES AND RESPONSIBILITIES:

• Manages a caseload of approximately 150–180 workers’ compensation claims of moderate to complex difficulty. *

• Calculates and establishes reserves and authorizes payments and settlements within assigned authority limits, which are lower than those assigned to Claims Examiner III. *

• Identifies and escalates claims involving significant exposure, unusual compensability issues, sensitive client concerns, or decisions exceeding assigned authority.*

• Refers claims to defense counsel as appropriate and monitors litigation activities, consulting with the supervisor on significant legal developments and settlement strategy.*

• Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.

QUALIFICATIONS REQUIRED:

Education/Experience: Bachelor’s degree in related field (preferred); and three (3) to five (5) 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 interact with people at all levels in the business environment.

• Ability to independently and effectively manage very complex claims.

• Proficient in Word and Excel (preferred).

Other Qualifications:

• Certification and/or or license as required by State regulation.