Workers Compensation Claims Examiner III

Level: Experienced,

Job Location:

Dallas
- Irving, TX 75038, Position Type:
Full Time, Education Level: High School Diploma or GED, Salary Range: $80,000.00 - $85,000.00 Salary/year,

Travel Percentage :
None,

Job Shift: Day, Job Category:
Admin
- Clerical,

Under minimal supervision, independently manages highly complex workers’ compensation indemnity claims, including litigated and high-exposure claims in the Texas jurisdiction, from inception through resolution. Applies advanced technical knowledge and judgment to develop claims strategies, resolve difficult issues, and make decisions within higher assigned authority limits and established company and client guidelines.

• Manages a caseload of approximately 125–150 workers’ compensation claims, with an emphasis on highly complex, litigated, and high-exposure indemnity claims.
• Evaluates difficult compensability, medical, disability, and litigation issues and develops appropriate claims resolution strategies.
• Establishes and adjusts reserves and authorizes payments and settlements within assigned authority limits, which are higher than those assigned to Claims Examiner II.
• Directs defense counsel and evaluates litigation strategy, significant legal developments, and settlement recommendations.
• Prepares detailed captioned reports addressing claim status, exposure, reserves, litigation strategy, and recommended resolution.
• Escalates matters exceeding assigned authority or requiring management involvement.
• Provides technical guidance to less experienced Claims Examiners as assigned, without formal supervisory responsibility.

Computer, 10-key, fax machine, copier, printer, and other office equipment.

Follow company dress code

• Education/
  
  Experience:
  
  High School Diploma or GED required;
  Bachelor’s degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.

• Advanced knowledge of Texas workers’ compensation laws, regulations, and claims handling requirements.
• Ability to independently manage highly complex, litigated, and high-exposure claims with minimal supervisory guidance.
• Ability to evaluate claims exposure, develop resolution strategies, and exercise sound judgment within assigned authority.

Certification and/or license as required by State regulation.

[see separate attachment for a copy of checklist of mental and physical requirements]

MENTAL AND

PHYSICAL REQUIREMENTS
1. MENTAL EFFORTa. Reasoning development:

Follow one- or two-step instructions; routine, repetitive task.

Carry out detailed but uninvolved written or verbal instructions; deal with a few concrete variables.

Follow written, verbal, or diagrammatic instructions; several concrete variables.

Solve practical problems; variety of variables with limited standardization; interpret instructions.

X Logical or scientific thinking to solve problems; several abstract and concrete variables.

Wide range of intellectual and practical problems; comprehend most obscure concepts.b. Mathematical development:

Simple additional and subtraction; copying figures, counting, and recording.

Add, subtract, multiply, and divide whole numbers.

X Arithmetic calculations involving fractions, decimals, and percentages.

Arithmetic, algebraic, and geometric calculations.

Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; require…