Claims Examiner

Claims Examiner III - Texas Compensation $60,000–$75,000 annually Remote Texas Workers' Compensation Adjuster License Required Overview We're partnering with a respected third-party administrator (TPA) specializing in workers' compensation claims to identify an experienced Claims Examiner III. This is an excellent opportunity for a seasoned Texas workers' compensation professional who thrives in a fast-paced environment, enjoys managing complex indemnity claims, and is committed to delivering exceptional service to clients and injured workers. In this role, you'll independently manage a caseload of complex workers' compensation claims from inception through resolution while working remotely as part of a collaborative claims team. Key Responsibilities • Independently manage a caseload of approximately 150 workers' compensation indemnity claims, including highly complex files. • Investigate claims promptly to determine compensability in accordance with Texas workers' compensation statutes and company guidelines. • Administer indemnity benefits, including handling TIBS, IIBS, SIBS, LIBS, and Death Benefits. • Coordinate and authorize appropriate medical treatment and medical billing. • Establish and maintain accurate claim reserves within assigned authority. • Refer claims to defense counsel when appropriate and oversee litigation strategy. • Communicate effectively with claimants, employers, medical providers, attorneys, vendors, and clients regarding claim status and resolution. • Maintain thorough documentation and diary management to ensure timely claim activity. • Conduct independent file reviews and maintain compliance with internal policies and regulatory requirements. • Partner with loss control professionals when appropriate to identify injury trends and workplace safety opportunities. • Perform additional duties as assigned. Qualifications Required • Active Texas Workers' Compensation Adjuster License. • Minimum 5 years of Texas workers' compensation indemnity claims experience. • Demonstrated experience handling: • Temporary Income Benefits (TIBS) • Impairment Income Benefits (IIBS) • Supplemental Income Benefits (SIBS) • Lifetime Income Benefits (LIBS) • Death Benefits • Strong knowledge of Texas workers' compensation statutes, regulations, and medical terminology. • Proven ability to independently manage complex claims from beginning to resolution. • Excellent analytical, organizational, negotiation, and decision-making skills. • Strong written and verbal communication skills with the ability to interact professionally with clients, claimants, attorneys, and medical providers. Preferred • Bachelor's degree in a related field. • Proficiency with Microsoft Word and Excel. Why This Opportunity • Fully remote opportunity serving the San Antonio/Corpus Christi, TX region. • Join a well-established workers' compensation organization with a collaborative claims team. • Manage complex, meaningful claims while maintaining autonomy in your work. • Opportunity to make a direct impact through quality claim handling and exceptional client service. • Stable organization with long-term career growth potential. Compensation & Benefits • Competitive salary of $60,000–$75,000, based on experience. • Remote work environment. • Comprehensive benefits package. • Paid time off and company holidays. • Professional development and ongoing training opportunities. • Supportive team culture with experienced leadership. Ready to Take the Next Step? If you're an experienced Texas Workers' Compensation Claims Examiner looking for a remote opportunity where your expertise is valued, we'd love to connect with you. Apply today to learn more about this confidential opportunity. Pay: $60,000.00 - $75,000.00 per year Benefits: • 401(k) • 401(k) matching • Dental insurance • Employee assistance program • Flexible spending account • Health insurance • Health savings account • Life insurance • Paid time off • Paid training • Parental leave • Prescription drug insurance • Professional development assistance • Referral program • Tuition reimbursement • Vision insurance • Wellness program • Work from home Work Location: Remote