Worker's Compensation Claims Adjuster II

This is a fully remote position, open to applicants in Texas.

📋 Description

• Manage a complex inventory of indemnity claims independently from intake through resolution.

• Ensure three-point contact within 24 hours for all new losses.

• Collect and analyze case facts, evaluate compensability, and keep current action plans updated.

• Detect and refer any fraud indicators to the Special Investigations Unit (SIU).

• Process claims in line with relevant statutes, service contracts, and company protocols.

• Oversee medical care throughout the claims lifecycle, which includes treatment authorization, medical control, UR and IME direction, and VR plan review.

• Collaborate with case managers to optimize early return-to-work opportunities.

• Assess and rate permanent disability in accordance with applicable state regulations.

• Establish, monitor, and modify case reserves within the assigned authority limits.

• Create precise and strategically clear 90-day carrier status reports.

• Direct defense counsel, formulate litigation strategies, manage legal budgets, and guide litigated files towards efficient resolution.

• Participate in mediations and settlement conferences, making decisions on settlement authority.

• Negotiate and finalize claim settlements, including the resolution of liens.

• Pursue subrogation, contributions from multiple defendants, and apportionment concerning pre-existing disability cases.

• Address inquiries within designated timeframes.

• Maintain proactive communication with injured workers, employers, carriers, counsel, and vendors.

⛳️ Requirements

• At least 3 years of experience in Texas Worker's Compensation claims adjusting with a Bachelor's degree.

• Minimum of 5 years of Texas Worker's Compensation claims adjusting experience without a Bachelor's degree.

• Proven ability to independently manage indemnity claims through to resolution.

• Active Texas Worker's Compensation or all lines license is required.

• Multi-state license is preferred.

• Professional designations such as AIC, ARM, or WCCP are advantageous.

• Solid understanding of Texas WC statutes.

• Experience directing defense counsel and managing litigated claims.

• Familiarity with claims management platforms is essential.

• Proficient in Microsoft Office.

• Capability to read and interpret medical records and IME reports.

• Candidates must reside in Texas, with a preference for those in the Austin area.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance.

• Contributions from the company to HSA and FSA plans.

• Employer-funded life and disability insurance.

• 401(k) plan with company matching contributions.

• Paid time off (PTO).

• Company-paid holidays.

• Access to employee assistance resources.

• A supportive culture that emphasizes balance and wellbeing.