Worker's Compensation Claims Adjuster II

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

📋 Description

• Effectively oversee a complex inventory of indemnity claims from initial intake to final resolution.

• Report to the Claims Supervisor of the unit and collaborate across a varied portfolio of self-insured client accounts.

• Conduct three-point contact within 24 hours for all new loss incidents.

• Collect and analyze case details, evaluate compensability, and keep up-to-date action plans.

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

• Manage claims in accordance with relevant statutes, service agreements, and company policies.

• Oversee medical care aspects, including treatment authorization, medical control, utilization review, IME direction, and vocational rehabilitation plan assessment.

• Collaborate with case managers to enhance early return-to-work outcomes.

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

• Integrate permanent disability evaluations into reserve and settlement plans.

• Set, monitor, and modify case reserves within designated authority limits.

• Generate precise 90-day carrier status reports.

• Guide defense counsel, determine litigation strategies, manage legal budgets, and drive litigated cases toward resolution.

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

• Negotiate and finalize claim settlements, including resolving liens.

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

• Respond to inquiries within stipulated timeframes.

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

⛳️ Requirements

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

• A minimum of 5 years of Texas Worker's Compensation claims adjusting experience in the absence of a Bachelor's degree.

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

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

• Multi-state license is preferred.

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

• Solid understanding of Texas Worker's Compensation statutes.

• Experience in directing defense counsel and managing litigated claims.

• Familiarity with claims management software platforms.

• Proficient in Microsoft Office applications.

• Capable of reading and interpreting medical records and IME reports.

• Candidates must reside in Texas.

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance options.

• Company contributions towards HSA and FSA plans.

• Employer-paid life and disability insurance coverage.

• 401(k) plan with company matching contributions.

• Paid time off (PTO).

• Company-observed holidays.

• Access to employee assistance resources.

• Supportive workplace culture that values balance and wellbeing.

• Complete benefits package.