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

Think Tell Junction

Entry Level Project Coordinator Job at Think Tell Junction

Join Our Team as a Entry Level Project Coordinator Think Tell JunctionThink Tell Junction We are seeking an enthusiastic and organized...  ...or individuals looking to kickstart their career in project management and coordination. As an Entry Level Project Coordinator, you... 

Hatch Global Search

Health Information Management Assistant Director OOJ - 35262 Job at Hatch Global Search

 ...Job Description In this role, you will manage HIM operations and staff, which includes...  ...reconciliation, processing release of information requests, hardcopy retrieval of medical...  ...the completion of physician charts. Health Information Management Assistant Director... 

B.B. Babies LLC.

Child Care Assistant Job at B.B. Babies LLC.

Summary Looking for a childcare assistant for an in-home daycare located in Alexandria Va. Schedule needed Mon / Tue / Fri: 11:00 AM 4:45 PM Wed / Thu: 8:00 AM 4:45 PM Are you interested in working in the childcare field working with children ages ...

Bayer

Seed Tech I Job at Bayer

 ...Seed Tech I At Bayer were visionaries, driven to solve the worlds toughest challenges and striving for a world where 'Health for all Hunger for none is no longer a dream, but a real possibility. Were doing it with energy, curiosity and sheer dedication, always... 

Rob Job Video

Remote Concept Artist Job at Rob Job Video

 ...sinister on closer inspection - grounded in real-world materials (fabric, foam, seams) Deliverables would include a small number of concept illustrations to hand off to SFX fabricator. How to Apply Please email ****@*****.*** with work examples. Thank you!...