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

Ukd0MTBKNkpadW52cjFtVDRsaFdSZnpNVWc9PQ==
  • Elite
  • Addison, 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
Elite

Job Tags

Similar Jobs

KeyBank National Association

Financial Wellness Banker - Kenai Job at KeyBank National Association

 ...current clients; effectively managing internal and external centers of influence. Ensuring compliance with operational, security and audit procedures and policies including appropriate documentation of client interactions. Participate in and occasionally facilitate... 

Pursuit Collection

Housekeeping & Laundry Attendant (Talkeetna) Job at Pursuit Collection

 ...housekeeping are maintained for our guests. Ensures cleanliness and efficient service of guest rooms and public areas, including; thorough cleaning of rooms and bathrooms, making beds, dusting, vacuuming, reporting preventative maintenance and handling of guest requests.... 

Senid Plumbing & Heating Corp.

Plumbing & Heating Mechanic Job at Senid Plumbing & Heating Corp.

 ...Senid Plumbing 14-20 128th St, Flushing, NY 11356, USA Busy Queens based plumbing shop in search of a plumber with a minimum of 7 years experience. Job Duties & Responsibilities (include but are not limited to):~ All aspects of plumbing and heating services... 

Guidehouse

Senior Financial Audit Consultant Job at Guidehouse

 ...organizations. Specific initiatives and work products that this role supports include: Supporting the response to external financial statement audit requests and inquiries to include end-to-end walkthroughs of business processes, ad hoc meetings, and assisting with coordinating... 

Nashville State Community College

Senior Administrative Assistant Job at Nashville State Community College

 ...entering requisitions, corresponding with vendors regarding invoices and tracking budget line items. Interacts and communicates with students, staff and community partners. Responds to inquiries from faculty and staff concerning technology matters. Tracks interactions...