Workers' Compensation Claims Examiner III

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

📋 Description

• Oversee all elements of indemnity claims management from start to finish, adhering to established authority and guidelines.

• Handle a caseload of 150 workers’ compensation files, including highly complex claims.

• Initiate and carry out timely investigations.

• Assess claim compensability and manage benefits in accordance with state law and Company policies.

• Supervise medical treatment and billing processes, authorizing as necessary.

• Refer cases to external defense counsel and direct/manage them as needed.

• Liaise with claimants, providers, and vendors concerning claims matters.

• Calculate and establish reserves within Company guidelines.

• Settle and/or finalize claims and secure designated authority.

• Maintain a diary system for case reviews and document file status and work completed.

• Relay pertinent information promptly to clients, including trends in injuries and safety concerns.

• Engage TRISTAR loss control personnel when necessary.

• Comply with Company policies and procedures.

• Conduct independent file reviews.

• Execute other assigned duties.

⛳️ Requirements

• Bachelor’s degree in a relevant field (preferred).

• A minimum of three (3) years of related experience.

• An equivalent combination of education and experience will be considered.

• Technical expertise in statutory regulations and medical terminology.

• Strong analytical abilities.

• Exceptional written and verbal communication skills, including the capacity to convey technical information to claimants, clients, and staff.

• Capability to interact effectively with individuals at all levels within the business environment.

• Proven ability to independently manage very complex claims successfully.

• Proficient in Word and Excel (preferred).

• Possession of a Texas Workers' Compensation License.

• Competency in using a computer, 10-key, fax machine, copier, printer, and other office equipment.

• Capacity to meet specified mental and physical demands, including light work and frequent talking, hearing, and repetitive wrist, hand, and finger movements.

🏝️ Benefits

• Medical, Dental, Vision Insurance.

• Life and Disability Insurance.

• 401(k) Plan.

• Paid Holidays.

• Paid Time Off.

• Referral bonus.