Workers Compensation Claims Examiner III

Workers Compensation Claims Examiner III

Hybrid Houston Office - Houston, TX 77040

Salary Range $75,000.00 - $83,000.00
Salary Level: Experienced
Position Type:
Full Time

Job Shift: Day
Education Level: High School Diploma or GED

Travel Percentage :
None
Category:
Admin - Clerical

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 Examiners, and other staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.

DUTIES AND RESPONSIBILITIES:

• Effectively manages a caseload of 110 to 150 workers' compensation files, 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 sets 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.

* 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:

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:

• 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).

Other

Qualifications:

• Texas Workers Compensation License

Here are some of the benefits you can enjoy in this role:

• Medical, Dental & Vision Insurance
• Life & Disability Insurance
• 401(k) plan
• Paid time off
• Paid holidays.

1. Mental Effort:
Reasoning, mathematical development, and language development including routine and complex problem solving, abstract and concrete reasoning, numerical calculations, and communication skills.

2. Physical Effort:
Sedentary work, light, medium, heavy, and very heavy work categories with force ranges (up to 100 pounds) and common occupational tasks such as lifting, carrying, pushing, pulling, standing, walking, reaching, and bending.

Visual Requirements:
Far vision, near vision, mid-range vision, depth perception, color vision, and field of vision must meet work demands.