Workers Compensation Claims Manager Jobs in Texas

Provide WC claims’ management education and WC regulatory updates to local business units.

Bachelor’s degree in Risk Management, Finance or Nursing background preferred

Ability to effectively work and collaborate with people with a wide range of skills, experience, cultures, and capabilities

Other duties as directed by management

Minimum seven (7) years of experience managing WC claims

WC technical knowledge and WC case law in multiple jurisdictions from Ohio to California

Manage all aspects of claims to resolution in accordance with jurisdictional requirements

Obtain appropriate state adjuster certification and continuing education credits

Establish appropriate claim reserve and manage reserve adequacy throughout life of claim

Negotiate skillfully in difficult situations to win concessions without damaging relationships

Minimum 3 years progressive work experience in administrative role

Bachelor's Degree in relevant field or equivalent work experience

Process payment of medical bills and invoices, meeting all statutory timeliness requirements

Minimum of one year of progressive office administration experience

Knowledge of workers’ compensation terminology preferred

Communicate with injured workers and service providers to facilitate claims administration

Provide injured workers with information about the workers’ compensation process

Handle multiple priorities simultaneously and effectively prioritize tasks to meet deadlines

Education & Licensing: 3+years of claims management experience or equivalent combination of education and experience required.

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.

Professional certification as applicable to line of business preferred.

Bachelor's Degree/or equivalent in Risk Management, Business, Finance, or related field.

Verbal and written communication skills necessary to communicate with all levels of management and third-party providers

Apply aggressive litigation cost management strategy on individual WC claim files

Adhere to quality management and compliance protocols

Ensure WC vendors are complying with service instructions and guidelines and escalate specific issues to Manager

Confirm initial and ongoing TPA reporting of WC claims requiring excess notification, and escalate claims meeting defined criteria to Manager

Prior experience handling claims reviews and litigation management

2+ years of experience handling Workers Compensation claims from inception to close including those in litigation

Active Adjuster's License in Texas

Minimum of 1 year of management experience

Requirements for the Operations Manager:

Salary: up to $68K/year (based on experience) + eligible for annual bonus

Compensation for the Operations Manager:

Proven track record of creating processes and leading a team to meet quality metrics

Location: On-site in North Dallas

Bachelor`s degree or equivalent in addition to 1-year claims handling experience. Knowledge of legal liability, insurance coverage and medical terminology preferred.

Manages an inventory of claims to evaluate compensability/liability.

Proven interpersonal, analytical and negotiation abilities required.

Establishes action plan based on case facts, best practices, protocols, regulatory issues and available resources.

Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability and damages.

Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims.

Previous medical case management experience a plus

Strong communication skills in order to build relationships with injured employees, medical professionals, employers, field claims staff and others

Good negotiation skills to effectively establish target return to work dates and coordinate medical care

Knowledge of state, local and federal laws related to health care delivery preferred

Personal computer knowledge and proficiency in general computer applications such as Internet Explorer and Microsoft Office (including Word, Excel and Outlook)

Must have additional professional certifications, such as CCM, COHN, CRRN, etc

Education: Bachelor’s Degree or equivalent experience.

We offer competitive healthcare, retirement, and paid time off benefits.

Essential Job Functions and Responsibilities

Experience: 6 to 10 years of related experience.

Reviews and evaluates coverage and/or liability.

Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) in the investigation of claims.

Updates Operations and Management on the status of all Workers Comp claims

Sends notifications to Benefits, and Operations to advise them that an employee is out of work for an injury.

Continually researches and maintains knowledge of developments in relevant codes, statues, and regulations with a particular emphasis on Workers’ Compensation

Reviews and monitors all Worker Comp claims ensuring accuracy and receipt of all necessary documentation

Determines claim type and analyze compensability to provide information to third party administrator (TPA)

Reviews claims with TPA regarding causation, to assess the medical, vocational and behavioral needs of injured worker and possible subrogation opportunities

Process payment of medical bills and invoices, meeting all statutory timeliness requirements

Minimum of one year of progressive office administration experience

Knowledge of workers’ compensation terminology preferred

Communicate with injured workers and service providers to facilitate claims administration

Provide injured workers with information about the workers’ compensation process

Handle multiple priorities simultaneously and effectively prioritize tasks to meet deadlines

Manage all aspects of claims to resolution in accordance with jurisdictional requirements

Obtain appropriate state adjuster certification and continuing education credits

Establish appropriate claim reserve and manage reserve adequacy throughout life of claim

Negotiate skillfully in difficult situations to win concessions without damaging relationships

Minimum 3 years progressive work experience in administrative role

Bachelor's Degree in relevant field or equivalent work experience

1+ years’ experience in Workers’ Compensation, Safety, or medical case management

Coordinate with management and employees on workplace accommodations for early return to work

Gain proficiency in Incident Management and Human Resource systems

Preference given to applicants with experience in manufacturing settings

Excellent interpersonal and communication skills

Ability to manage multiple priorities simultaneously to achieve expected results

Advise division managers and safety professionals on claim experience and reserves to inform safety initiatives

Manage vendor services, including third party administrators, bill pay, and insurance carriers

Manage legal services necessary to defend the Company concerning contested or litigated claims

Work with facility managers and supervisors to promote interactive process and early return to work

At least five years’ experience with Workers’ Compensation or similar matters, preferably in California

Preference given to applicants who possess self-insured certifications in CA and WA