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

Goodwill Industries of San Diego County

Processing Worker I Job at Goodwill Industries of San Diego County

 ...assists in stocking the floor and pulling merchandise. Opens and closes donations area. Accepts and safeguards donations and keeps processing and donation areas in a clean, safe and organized manner. Provides excellent customer service to donors and customers.... 

Bayer

Tech Agronomist III: New York/ New England Job at Bayer

 ...At Bayer we're visionaries, driven to solve the world's toughest challenges and striving for a world where 'Health for all Hunger for none' is no longer a dream, but a real possibility. We're doing it with energy, curiosity and sheer dedication, always learning from unique... 

TriCorps

Armed Security Officer Job at TriCorps

 ...Job Description Armed Security Officer (Security) Tulsa, OK, United States of America $ 22.00 - $ 22.00 Back Apply Now Back Apply Now Overview TriCorps is an integrated security and technology firm specializing in providing cost-effective, world-class... 

Med Source Consultants

Family Medicine Physician - 3111 Job at Med Source Consultants

 ...Family Medicine Physician 3111 Internal or Family Medicine physician Visa Sponsorship Available!* Away from the Hustle and Bustle and Close to Fun; Newport and the Cape!* Superior organization looking for a Family Medicine physician for one of their outpatient... 

Altom Transport

Company Driver - CDL A - Tanker Driver Job at Altom Transport

 ...Choose Your Driving Option ~ Regional Driver ~ Home every few days (35 days...  ...Responsibilities ~ Safely operate tanker trucks transporting bulk liquid materials...  ...interactions Requirements ~ Valid CDL Class A License Tanker...