Top 50 Senior claims representative Jobs in Texas

Senior Workers Compensation Claims Adjuster
INSURICA, Inc. —Marble Falls, TX
- $75,000 - $112,000 a year
- Full-time
- Spanish
- Writing skills
- Mentoring
Senior Audit Representative
Optum —Dallas, TX
- $20 - $36 an hour
- 8 hour shift
- Remote
- 18 years or older
- Pass drug screening
- Windows
- On-the-job training
5d
Director & Senior Counsel, Complex Claims
Markel Service Inc. —Plano, TX
- $136,840 - $235,235 a year
- Email
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Analysis skills
- AD&D insurance
- Employee stock purchase plan
Quick Apply
9d
Senior Workers' Compensation Claims Examiner - Federal Claims
AIG Claims, Inc. —Houston, TX
- $73,000 - $96,000 a year
- Email
- Customer service
- Writing skills
- Office
- Health insurance
Quick Apply
Senior Claims Specialist I
Liberty Mutual —Plano, TX
- $67,000 - $126,000 a year
- Full-time
- Office
- 3 years
- Bachelor's degree
9d
Senior Claims Representative - REMOTE
Ryder System —Austin, TX
- $75,000 - $80,000 a year
- Remote
- Management
- 5 years
- Bachelor's degree
- Disability insurance
- Health insurance
Senior Claims Representative
Liberty Mutual —Plano, TX
- $46,000 - $84,000 a year
- Full-time
- Remote
- Customer service
- Research
- Mid-level
- Paid training
10d
Senior Claims Specialist
Liberty Mutual —Plano, TX
- $67,000 - $126,000 a year
- Full-time
- Office
- 3 years
- Bachelor's degree
Sr. Claim Representative/Claim Consultant
The Hartford —San Antonio, TX
- $62,400 - $127,200 a year
- Full-time
- Hybrid work
- Microsoft Excel
- 5 years
- Office
ESIS Senior Claims Representative, WC
Chubb —Dallas, TX
- Full-time
- 5 years
- Organizational skills
- Senior level
Senior Auto Appraiser – Field (Northwest Austin Territory)
USAA —Austin, TX
- $63,590 - $114,450 a year
- Weekends as needed
- Hybrid work
- Military
- High school diploma or GED
- Driver's License
- Paid holidays
- Health insurance
9d
Senior Patient Services Representative - Neuroscience (Sugar Land)
Houston Methodist Specialty Physician Group —Sugar Land, TX
- Full-time
- Inventory management
- Word processing
- Writing skills
8d
Senior CSM, PBM
Rightway —Dallas, TX
- $125,000 - $145,000 a year
- 5 years
- Research
- Master's degree
Quick Apply
Senior Out-of-Network & IDR Billing Specialist
Incise AI —Texas
- $76,031.30 - $91,564.58 a year
- Contract
- Remote
- Surgery
- 5 years
- Senior level
Quick Apply
Clinic Patient Representative Senior - Texarkana Specialty Vascular Surgery
Christus Health —Texarkana, TX
- Full-time
- Surgery
- HIPAA
- Mid-level
2d
Disability Representative Sr
Sedgwick —Irving, TX
- Hybrid work
- Writing skills
- Office
- High school diploma or GED
- Health savings account
- Disability insurance
Senior Call Center Representative - Member Services
Texas Children's Hospital —Bellaire, TX
- Full-time
- HIPAA
- Mid-level
- High school diploma or GED
Clinic Patient Representative Senior - Specialty Eye Care
Christus Health —Mineola, TX
- Full-time
- HIPAA
- Mid-level
- 3 years
8d
Clinic Patient Representative Senior - Tyler Specialty Endocrinology
Christus Health —Tyler, TX
- 8 hour shift
- HIPAA
- Mid-level
- 3 years
Senior Customer Service Representative
Graybar Electric Company, Inc. —Jersey Village, TX
- Full-time
- High school diploma or GED
- Bachelor's degree
- Senior level
- Profit sharing
- Paid holidays
Quick Apply
8d

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Senior Workers Compensation Claims Adjuster

INSURICA, Inc. -
Marble Falls, TX

Apply Now

Job Details

Full-time
$75,000 - $112,000 a year

Qualifications

Spanish
Confidential information handling
EDI
Witness interviews for accident investigation
Writing skills
Regulatory compliance in claims processing
Claims negotiation
Workers' compensation insurance knowledge
Insurance investigation report preparation
Insurance regulation
Personal injury dispute resolution
Task prioritization
Decision making
Compliance documentation
Mentoring
Organizational skills
Bodily injury claims
Insurance claims status tracking
Claims documentation management
Senior level
Documentation Handling
All-Lines Adjuster License
Subrogation claims
Medical terminology
Cross-functional communication

Full Job Description

Job Summary

The Worker’s Compensation Claims Adjuster will manage a caseload of approximately 150 open claims, exercising good judgment while resolving claims according to our established procedures and best claims practices, in accordance with statutory, regulatory, and ethics requirements.

Job Functions

Receive and review initial workers’ compensation claims, verifying the accuracy and completeness of claim forms and supporting documentation
Conduct thorough investigations to determine validity and extent of injury; interview the injured employee, employer(s) and any witnesses, as well as review medical reports, and accident reports to determine causality and compensability
Effectively communicate with the injured worker, employer(s), medical professionals and legal representatives, as needed, providing ongoing updates and information to all parties involved in the claim process
Make appropriate determinations on the approval or denial of claims, based on investigation findings and applicable laws; calculate correct benefit amounts, including medical expenses, wage replacement and any other necessary compensation
Manage and monitor open claims to ensure timely and appropriate processing; coordinate return-to-work programs and rehabilitation services
Effectively maintain detailed and accurate records for each claim; prepare and submit required documentation and reports to regulatory bodies
Timely initiation, maintenance, and termination of temporary, impairment, and supplemental income benefits
Identify and pursue subrogation when there is 3rd party negligence, and negotiate a fair settlement for all parties involved
Address and resolve any disputes or issues that arise during the claim process
Serve as a subject matter expert and mentor to Workers’ Compensation Claims Adjuster staff members, providing guidance and direction, as needed, for difficult or unusual claims or client situations
Review all activities relating to the public, customers, and companies to avoid issues involving potential errors and omissions and ensure compliance with workers’ compensation laws and regulations
Participate in seminars and other training to maintain required licenses and for knowledge and skill development

Additional Responsibilities

This job description is intended to describe the level of work required of the person performing the position. Essential functions are outlined; however, other duties may be assigned, as needs arise, or as required to support the essential functions. Specific performance objectives may be developed each year to measure the performance of the tasks and functions listed in this job description.

Remote work opportunities vary by location, department, and business need and are subject to change, as needed. Each manager will provide details on any telecommuting opportunities, as well as scheduling, within their department

Job Requirements

5 – 7 years of previous workers’ compensation claims handling experience preferred
Possession of a current Texas Workers’ Compensation Adjuster License or an All-Lines Adjuster License ris equired
Spanish language skills (speak and understand) preferred, but not required

Knowledge, Skills, and Abilities

Strong judgment and decision-making skills, with the ability to effectively analyze claims exposure to determine the proper course of action
Extensive knowledge of Workers’ Compensation law, industry standards and medical and legal terminology
Strong working knowledge of the Texas Workers’ Compensation Act, including specific rules and case law
Strong working knowledge of various medical services normally provided to injured workers
Knowledge of EDI (Reporting requirements for the State of Texas)
Excellent organizational skills, demonstrating attention to detail, accuracy and ability to meet deadlines
Ability to work within a fast-paced, changing priority environment
Self-motivated, with the initiative to prioritize and be self-directed
Regular and punctual attendance is required
Ability to communicate effectively, both verbally and in writing,
Excellent interpersonal skills, with the ability to interact effectively with both colleagues and managers, across all levels
Ability to promote and maintain a team environment, willing to find accommodating solutions for our customers, companies, and the Agency
Ability to successfully adhere to company policies and procedures, as well as maintain strict confidentiality

Work Conditions

Ability to perform approximately 90% sedentary work, exerting up to 10 pounds of force occasionally, and negligible force frequently
Ability to lift up to 20 pounds, occasionally
Requires operation of a computer workstation, including keyboard and video display
All requirements may be modified to reasonably accommodate physical or mental impairment

Apply Now

Refine Your Search

senior claims representative jobs in texas

Senior Workers Compensation Claims Adjuster

Senior Audit Representative

Director & Senior Counsel, Complex Claims

Senior Workers' Compensation Claims Examiner - Federal Claims

Senior Claims Specialist I

Senior Claims Representative - REMOTE

Senior Claims Representative

Senior Claims Specialist

Sr. Claim Representative/Claim Consultant

ESIS Senior Claims Representative, WC

Senior Auto Appraiser – Field (Northwest Austin Territory)

Senior Patient Services Representative - Neuroscience (Sugar Land)

Senior CSM, PBM

Senior Out-of-Network & IDR Billing Specialist

Clinic Patient Representative Senior - Texarkana Specialty Vascular Surgery

Disability Representative Sr

Senior Call Center Representative - Member Services

Clinic Patient Representative Senior - Specialty Eye Care

Clinic Patient Representative Senior - Tyler Specialty Endocrinology

Senior Customer Service Representative

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