Workers’ compensation medical only claims adjuster | remote

Our client is seeking a Workers’ Compensation Medical Only Claims Adjuster to join their Texas team. This person will oversee and manage medical-only workers’ compensation claims, ensuring timely evaluations, appropriate medical care, and efficient claim resolutions. This is an excellent opportunity for a claims professional who enjoys investigating workplace injuries, working closely with medical providers, and managing claims from initial reporting through closure.

The ideal candidate will have a strong understanding of workers’ compensation regulations, medical billing practices, and claims administration.

Responsibilities

• Handle a caseload of medical-only workers’ compensation claims involving exposures up to $10,000.
• Investigate reported workplace injuries, gather supporting documentation, and evaluate claim eligibility.
• Review claim details to make appropriate compensability decisions in accordance with applicable workers’ compensation regulations.
• Oversee medical treatment activities, review provider invoices, and approve services within established authorization limits.
• Maintain regular communication with injured employees, employers, healthcare professionals, and other involved parties.
• Establish and update claim reserves based on medical expenses, claim developments, and anticipated exposure.

Qualifications

• 1-3 years of workers' compensation medical only or claims associate experience.
• Experience managing medical-only workers’ compensation claims preferred.
• Active Texas adjusters license.
• Understanding of workers’ compensation laws, medical terminology, and applicable state regulations.
• Familiarity with medical billing, treatment coordination, compensability determinations, and claim reserving.
• Ability to evaluate medical records, investigate claims, and identify potential changes in claim exposure.

Salary & Benefits

• $50,000 - $60,000 annually (depending on experience)
• Competitive Medical, Dental and Vision plans
• Employer match 401(k)
• Paid Holidays & Paid Time off
• Advancement opportunities internally within the organization