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

Tutor Doctor of Morris County

Math Tutor (All Levels Needed) Job at Tutor Doctor of Morris County

In-Person Tutors Needed! If you are not willing to travel to these towns and tutor in-person...  ...(TDMC) team is searching for a dynamic math tutor to ignite the academic journey of...  ...As a boutique, one-on-one, in-home, and online tutoring company, our mission is to transform... 

Weezie

Copywriter Job at Weezie

 ...and time management skills. What You Can Expect ~ Hybrid work environment: You will work from our Westside Provisions District...  ...works hard but knows how to #enjoythestay ~ Unlimited PTO plus remote work during July 4th week and an office closure the week after... 

CarVision Inc.

Data Entry Specialist Part Time Evenings Job at CarVision Inc.

 ...general office equipment (i.e., copier, fax machine, etc.)* Ability to sit or stand for prolonged periods of time* Ability to perform repetitive data entry tasks, manual dexterityWhat We Offer* PT Flexibility* Closed on Sundays* Free Cell Line for every associate... 

Fair Haven Community Health Care

Medical Assistant (Pediatrics) Job at Fair Haven Community Health Care

 ...to delivering high-quality, affordable medical and dental care to everyone, regardless...  ...responsive patient-centered care. Medical Assistants work with clinicians and nurses to...  ...in Spanish preferred. Experience in Pediatric care preferred. The selected candidate... 

Cynomi

Sales Engineer Job at Cynomi

 ...As a Sales Engineer atCynomi, you will own the full technical journey of our US MSP/MSSP partners, from Discovery through Proof of Value, Close, Onboarding, and Adoption. You will drive decision clarity, design and execute high-impact Proof of Value processes, and help...