Claims Examiner III
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