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Claims Adjuster - Workers Compensation

QuestPro Consultants Dallas Full-Time
$55,000.00/ year
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Title:  Lost Claims’ Examiner – Workers’ Compensation

Innovative employee friendly Claims’ Third Party Administrator(TPA) has a brand new opening for a customer centric up and comer  with in the TX Workers' Compensation Adjuster Arena.  Position will be onsite (flexible M-F work schedule) in their Dallas Branch.  File counts are kept to a minimum with helpful Administrative staff and user friendly efficient software systems.  Qualified Applicants MUST have direct Lost Time Claims handling experience and active TX Adjusters' License, exposure to OK & AR is a plus.

General Description:

Manage within company standards and best practices complex and problematic high visibility workers' compensation claims within delegated limited authority to determine benefits due, work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer requirements to achieve the best possible outcome in the claim.

Essential Job Duties:

Receives claim, confirms policy coverage & acknowledgement of claim

Determine validity & compensability of claim by investigating & gathering info, file necessary documentation with state agencies

Establish reserves & authorize payments within reserving authority limits

Develop and manage well documented action plan with case manager, attorney, supervisor & client to reduce overall cost of claim

Coordinating early return to work efforts with case manager & employer

Negotiates settlements when necessary

Actively manage the litigation process

Identifies potential subrogation claims

Communicate claim status with customer and claimant

Adhere to client guidelines & participate in claim reviews as needed

Develops & maintains professional customer relationships

Education/Training Requirements:

Degree at an accredited college or university preferred

Three years handling claims WC Lost Time

Excellent oral, written communication skills & customer service

PC literate, including Microsoft Office (Word, Excel)

Effective analytical & interpretive skills

Strong organizational skills

Great interpersonal skills

Skills: claims, workers compensation, adjuster, Bonus:  Reason Open: replacement


Recommended skills

Interpersonal Skills
Written Communication
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Job ID: BHJOB26588_15542


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