Claims Supervisor – Texas Workers’ Compensation

Position Summary

The Claims Supervisor is responsible for supervising and monitoring the accuracy, timeliness, and quality of workers’ compensation claims within an assigned Texas claims unit. This position provides day-to-day leadership and technical claims guidance to staff, makes claims decisions, reviews files for accuracy, approves payments and reserve increases above examiner authority, and ensures quality claim handling and resolution.

The Claims Supervisor also manages team performance and development while maintaining productive client relationships and ensuring compliance with client handling instructions and established claims best practices.

Primary Responsibilities

Claims Leadership

• Supervise the handling and resolution of Texas workers’ compensation claims.
• Make claims decisions regarding plans of action, payments, reserves, settlements, and overall claim handling.
• Review claim files for accuracy, quality, appropriate reserves, and proper resolution.
• Authorize payments and settlements and approve payments and reserve increases above examiner authority levels.
• Ensure consistent and accurate claims coding and documentation.
• Monitor file quality, claims analysis, action plans, and unit closing goals.
• Review and analyze claims reports for accuracy and performance.
• Collaborate with management, clients, and attorneys regarding settlements and litigation strategies.
• Communicate with clients, attorneys, medical providers, investigators, and injured workers.
• Work with medical case management regarding the appropriateness of medical treatment.
• Identify opportunities to improve and streamline claims processes.

Employee Management

• Provide direct supervision for approximately 6–10 claims professionals.
• Plan, organize, prioritize, and delegate team workloads.
• Monitor daily team activities, claim progress, quality, and compliance.
• Coach and train staff to improve claims knowledge and performance.
• Participate in interviewing, onboarding, and training new employees.
• Conduct performance evaluations, provide feedback, establish goals, and identify development opportunities.
• Address performance, disciplinary, employee relations, and workflow issues in coordination with Human Resources as appropriate.
• Lead regular team meetings and maintain open communication with staff.

Client Management

• Work with clients regarding claims, policies, and program-related issues.
• Maintain client relationships through regular communication, accessibility, and proactive problem-solving.
• Attend client meetings, claim reviews, internal meetings, and workers’ compensation meetings.
• Ensure diaries, documentation, and action plans are timely, meaningful, well-written, and compliant with client handling instructions and claims best practices.
• Monitor audit results to ensure claims handling meets applicable client and quality standards.
• Document client meetings and significant communications.

Required Qualifications

Education & Licensing

• High School Diploma or GED required; Associate or Bachelor’s degree preferred.
• Texas Workers’ Compensation or All Lines License required

Experience

• Minimum 3+ years of recent Texas workers’ compensation claims handling experience at a high level.
• Minimum 2 years of Claims Supervisory experience required.
• 5+ years of workers’ compensation lead or supervisory experience preferred.
• Prior Third-Party Administrator (TPA) experience preferred.

Technical & Claims Knowledge

• In-depth knowledge of Texas workers’ compensation laws, policies, and procedures.
• Proficiency in determining case value, reserving, and negotiating settlements.
• Understanding of medical and legal terminology.
• Ability to plan, prioritize, and organize claims workloads for a unit.
• Strong analytical, reasoning, and problem-solving skills.
• Ability to exercise independent judgment in complex and sensitive situations.
• Proficiency with Microsoft Office Suite and ability to learn claims management systems and other technology.
• Ability to create and analyze reports.

Leadership & Communication Skills

• Demonstrated ability to lead, coach, motivate, and develop claims staff.
• Ability to delegate effectively and ensure timely completion of work.
• Strong organizational and time-management skills.
• Ability to develop effective working relationships with employees, clients, attorneys, vendors, and other stakeholders.
• Strong written and verbal communication skills.
• Strong attention to detail and documentation.
• Effective and tactful negotiation skills.
• Ability to handle confidential and sensitive information appropriately.

Additional Requirements

• Valid driver’s license and ability to travel as needed for in-office file reviews and meetings.
• Ability to type quickly and accurately for sustained periods.