Senior Workers Compensation Claims Adjuster

Location: Marble Falls

Job Summary The Worker’s Compensation Claims Adjuster will manage a caseload of approximately 150 open claims, exercising good judgment while resolving claims according to our established procedures and best claims practices, in accordance with statutory, regulatory, and ethics requirements.

Job Functions Receive and review initial workers’ compensation claims, verifying the accuracy and completeness of claim forms and supporting documentation

Conduct thorough investigations to determine validity and extent of injury; interview the injured employee, employer(s) and any witnesses, as well as review medical reports, and accident reports to determine causality and compensability

Effectively communicate with the injured worker, employer(s), medical professionals and legal representatives, as needed, providing ongoing updates and information to all parties involved in the claim process

Make appropriate determinations on the approval or denial of claims, based on investigation findings and applicable laws; calculate correct benefit amounts, including medical expenses, wage replacement and any other necessary compensation

Manage and monitor open claims to ensure timely and appropriate processing; coordinate return-to-work programs and rehabilitation services

Effectively maintain detailed and accurate records for each claim; prepare and submit required documentation and reports to regulatory bodies

Timely initiation, maintenance, and termination of temporary, impairment, and supplemental income benefits

Identify and pursue subrogation when there is 3rd party negligence, and negotiate a fair settlement for all parties involved

Address and resolve any disputes or issues that arise during the claim process

Serve as a subject matter expert and mentor to Workers’ Compensation Claims Adjuster staff members, providing guidance and direction, as needed, for difficult or unusual claims or client situations

Review all activities relating to the public, customers, and companies to avoid issues involving potential errors and omissions and ensure compliance with workers’ compensation laws and regulations

Participate in seminars and other training to maintain required licenses and for knowledge and skill development

Additional Responsibilities This job description is intended to describe the level of work required of the person performing the position. Essential functions are outlined; however, other duties may be assigned, as needs arise, or as required to support the essential functions. Specific performance objectives may be developed each year to measure the performance of the tasks and functions listed in this job description.

Remote work opportunities vary by location, department, and business need and are subject to change, as needed. Each manager will provide details on any telecommuting opportunities, as well as scheduling, within their department

Job Requirements 5 – 7 years of previous workers’ compensation claims handling experience preferred

Possession of a current Texas Workers’ Compensation Adjuster License or an All-Lines Adjuster License ris equired

Spanish language skills (speak and understand) preferred, but not required

Knowledge, Skills, and Abilities Strong judgment and decision-making skills, with the ability to effectively analyze claims exposure to determine the proper course of action

Extensive knowledge of Workers’ Compensation law, industry standards and medical and legal terminology

Strong working knowledge of the Texas Workers’ Compensation Act, including specific rules and case law Strong working knowledge of various medical services normally provided to injured workers

Knowledge of EDI (Reporting requirements for the State of Texas)
Excellent organizational skills, demonstrating attention to detail, accuracy and ability to meet deadlines

Ability to work within a fast-paced, changing priority environment

Self-motivated, with the initiative to prioritize and be self-directed

Regular and punctual attendance is required

Ability to communicate effectively, both verbally and in writing,Excellent interpersonal skills, with the ability to interact effectively with both colleagues and managers, across all levels

Ability to promote and maintain a team environment, willing to find accommodating solutions for our customers, companies, and the Agency Ability to successfully adhere to company policies and procedures, as well as maintain strict confidentiality

Work Conditions Ability to perform approximately 90% sedentary work, exerting up to 10 pounds of force occasionally, and negligible force frequently

Ability to lift up to 20 pounds, occasionally

Requires operation of a computer workstation, including keyboard and video display

All requirements may be modified to reasonably accommodate physical or mental impairment
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