Sr. Claims Adjuster (Workers Compensation) Job at Elite, Austin, TX

RUxDWENRcUxMVzBTeldQeXhvKy9lM1JoQ2c9PQ==
  • Elite
  • Austin, TX

Job Description

Must have TEXAS workers' compensation license and seeking 5 years experience in lost time work comp claims for TEXAS jurisdiction.

POSITION SUMMARY:
Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

DUTIES AND RESPONSIBILITIES:
  • Effectively manages a caseload of 110 to 160 workers’ compensation files, including very complex claims.*
  • Initiates and conducts investigation in a timely manner.*
  • Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.*
  • Manages medical treatment and medical billing, authorizing as appropriate.*
  • Communicates with claimants, providers and vendors regarding claims issues.*
  • Computes and set reserves within Company guidelines. 
  • Maintains diary system for case review and documents file to reflect the status and work being performed on the file.*
  • Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.*
  • Adheres to all Company policies and procedures.*
  • Conducts file reviews independently.*
  • Other duties as assigned.
* Essential job function.

EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment.

QUALIFICATIONS REQUIRED:
Education/Experience : High School Diploma or GED required. Bachelor’s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience. 

Knowledge, Skills and Abilities :
  • Technical knowledge of statutory regulations and medical terminology.
  • Analytical skills.
  • Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
  • Ability to interact with persons at all levels in the business environment.
  • Ability to independently and effectively manage very complex claims.
  • Proficient in Word and Excel (preferred).
Other Qualifications :
  • Texas Workers Compensation License

Job Tags

Similar Jobs

Two95 International Inc.

Project Manager (Remote) Job at Two95 International Inc.

 ...Title: Project Manager Location: Remote Position: 6+ Months (Contract) Rate: $Open Requirements Responsibilities: Experience managing large highly-complex IT system development projects Knowledge of and experience using industry standard... 

Appt-Cnt-Exec

Entry Level Customer Service Representative Job at Appt-Cnt-Exec

We are seeking a driven and customer-focused individual to join our team as a Customer Service Representative. In this role, your primary responsibility will be to ensure the success and satisfaction of our current customers while offering support in a professional and...

JPMorgan Chase Bank, N.A.

Investment Banking - Power & Renewables- Associate Job at JPMorgan Chase Bank, N.A.

Job Summary As an Associate in our Natural Resources group, you will be a key player in our business strategy and execution. You will participate in the \"full cycle\" of transactional execution including preparing marketing pitches, reviewing and formulating financial...

Super Soccer Stars

Preschool Sports Coach / Creative Movement Instructor - Part Time Job at Super Soccer Stars

 ...playful and stimulating environment, you may be our next JumpBunch Coach!! We are currently seeking energetic individuals to teach...  ...to a federal criminal background check. Be in good physical condition and able to bend, kneel, stoop, jump, jog, and otherwise move actively... 

Cabanas Law Firm

System Administrator Job at Cabanas Law Firm

 ...Fastest-Growing Divorce Law FirmDo you love fast growth, tight systems, and solving problems before anyone notices them?Are you the...  ...time?Can you support a team spread across multiple offices AND remote locations without missing a beat?If yes this is your lane.We...