Claims Examiner Worker's Compensation
Dallas, Texas
An innovative and 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
JOB OVERVIEW