Workers Compensation Claims Examiner III _Corpus_Christi_; Hybrid

Level:
Experienced

Job Location:
Corpus Christi, TX

Position Type:
Full Time

Education Level:
High School Diploma or GED

Salary Range: $75,000 - $85,000

Travel Percentage:
None

Job Shift:
Day

Job Category:
Insurance

THIS POSITION CAN BE HYBRID. PLEASE SIGN THE APPLICATION AT THE END.

POSITION SUMMARY: Under minimal supervision, manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

This position requires interaction with clients, claimants, management, other Claims Examiners, and staff in the office; therefore, punctuality and presence in the office are essential.

• Manage a caseload of 150-180 workers’ compensation files, including complex claims.
• Initiate and conduct investigations promptly.
• Determine claim compensability and administer benefits according to state law and company guidelines.
• Manage medical treatment and billing, authorizing as appropriate.
• Communicate with claimants, providers, and vendors regarding claims issues.
• Compute and set reserves within company guidelines, with limits up to $1,000,000.
• Maintain diary system for case review and update files accordingly.
• Promptly communicate claim information to clients to ensure efficiency.
• Involve loss control staff when appropriate.
• Adhere to all company policies and procedures.
• Perform other duties as assigned.

Equipment Operated/Used: Computer, 10-key, fax machine, copier, printer, and other office equipment.

Special Equipment or Clothing: Appropriate office attire.

Required Education/Experience: High School Diploma or GED;
Bachelor’s degree preferred; 5+ years of related experience or equivalent.

Knowledge, Skills, and Abilities:

• Knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent communication skills, both written and verbal.
• Ability to interact at all levels within the business environment.
• Ability to manage complex claims independently.
• Proficiency in Word and Excel preferred.

Other Qualifications: Texas Workers Compensation License.

• Medical, Dental, Vision, Disability & Life Insurance
• 401(k) Plan
• Paid time off
• Paid holidays
• Referral bonus