Worker's Compensation Claims Adjuster III

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

📋 Description

• Analyze intricate, catastrophic, and high-exposure workers’ compensation claims.

• Conduct three-point contact for all new losses and maintain comprehensive action plans focused on strategic resolutions.

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

• Collect and document information regarding claims that involve multi-party liability, catastrophic injuries, significant subrogation opportunities, or unique legal challenges.

• Oversee medical management, direct specialists, coordinate life care planners, manage Utilization Reviews (UR) and Independent Medical Examinations (IMEs), and handle Permanent Total Disability (PTD) cases.

• Collaborate with case managers to optimize early return-to-work initiatives and review costly or atypical medical treatments.

• Guide permanent disability ratings for complex cases.

• Establish and modify reserves on high-exposure files with appropriate documentation.

• Ensure status reports align with client reporting schedules and formats.

• Manage litigation processes, including the selection of defense counsel, strategy formulation, expert retention, legal expenditure management, and trial preparation.

• Facilitate mediations, settlement discussions, and arbitrations.

• Make or propose high-value settlement authority decisions in collaboration with the Claims Supervisor and client.

• Negotiate and finalize high-value settlements, including Compromise & Release (C&R) and Stipulated Awards.

• Oversee multi-lien resolutions and collaborate with lien counsel and CMS.

• Actively pursue subrogation, contributions from multiple defendants, and apportionment recovery.

• Coordinate with recovery vendors and external subrogation counsel.

• Provide technical support for the Claims Supervisor and offer guidance on complex decisions, reserve adequacy, and escalated client matters.

• Mentor Adjuster I and II colleagues while contributing to unit-wide quality assessments.

• Serve as a senior point of contact for key client accounts, fostering relationships with clients and carriers.

• Maintain proactive and transparent communication, responding within specified timeframes.

⛳️ Requirements

• A minimum of 7 years of experience in WC claims, including at least 5 years of independent indemnity management with specialization in complex, high-exposure, and litigated files; or a Bachelor’s degree combined with at least 5 years of independent-level WC indemnity experience; or an equivalent combination.

• Extensive knowledge of public entity liability claims, including Joint Powers Authorities (JPAs), self-insured programs, and pooled insurance frameworks.

• An active Texas Worker's Compensation or all-lines license is required; multi-state licensing is preferred.

• Professional designations such as AIC, ARM, WCCP, or CPCU are advantageous but not mandatory.

• In-depth understanding of Texas WC statutes.

• Multi-jurisdictional experience is highly regarded.

• Direct experience with one or more claims administration or processing systems commonly utilized in workers’ compensation insurance handling.

• Proven track record of managing complex litigation through mediation, settlement conferences, and trial preparations.

• Advanced understanding of Permanent Disability (PD) ratings, Medicare Set-Aside (MSA) requirements, and multi-party lien resolutions.

• Experience in managing catastrophic injuries and coordinating life care planning.

• Familiarity with claims management platforms.

• Proficient in Microsoft Office applications.

• Demonstrated ability to mentor junior adjusters and act as a supervisory backup or senior technical advisor.

• Strong skills in client relationship management.

• Experience in addressing escalated concerns at a senior level.

• Must reside in Texas, with a preference for the Austin area.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage.

• Company contributions to Health Savings Account (HSA) and Flexible Spending Account (FSA) plans.

• Employer-paid life and disability insurance.

• 401(k) plan with company matching.

• Paid time off (PTO) and company-observed holidays.

• Access to employee assistance resources.

• A supportive culture that prioritizes work-life balance and well-being.

• Option for remote work arrangements.