Claims Examiner III

Compensation

$60,000–$75,000 annually

Remote

Texas Workers' Compensation Adjuster License Required

Overview

We're partnering with a respected third-party administrator (TPA) specializing in workers' compensation claims to identify an experienced Claims Examiner III. This is an excellent opportunity for a seasoned Texas workers' compensation professional who thrives in a fast-paced environment, enjoys managing complex indemnity claims, and is committed to delivering exceptional service to clients and injured workers.

In this role, you'll independently manage a caseload of complex workers' compensation claims from inception through resolution while working remotely as part of a collaborative claims team.

Key Responsibilities

• Independently manage a caseload of approximately 150 workers' compensation indemnity claims, including highly complex files.
• Investigate claims promptly to determine compensability in accordance with Texas workers' compensation statutes and company guidelines.
• Administer indemnity benefits, including handling TIBS, IIBS, SIBS, LIBS, and Death Benefits.
• Coordinate and authorize appropriate medical treatment and medical billing.
• Establish and maintain accurate claim reserves within assigned authority.
• Refer claims to defense counsel when appropriate and oversee litigation strategy.
• Communicate effectively with claimants, employers, medical providers, attorneys, vendors, and clients regarding claim status and resolution.
• Maintain thorough documentation and diary management to ensure timely claim activity.
• Conduct independent file reviews and maintain compliance with internal policies and regulatory requirements.
• Partner with loss control professionals when appropriate to identify injury trends and workplace safety opportunities.
• Perform additional duties as assigned.

Qualifications

Required

• Active Texas Workers' Compensation Adjuster License.
• Minimum 5 years of Texas workers' compensation indemnity claims experience.
• Demonstrated experience handling:
• Temporary Income Benefits (TIBS)
• Impairment Income Benefits (IIBS)
• Supplemental Income Benefits (SIBS)
• Lifetime Income Benefits (LIBS)
• Death Benefits
• Strong knowledge of Texas workers' compensation statutes, regulations, and medical terminology.
• Proven ability to independently manage complex claims from beginning to resolution.
• Excellent analytical, organizational, negotiation, and decision-making skills.
• Strong written and verbal communication skills with the ability to interact professionally with clients, claimants, attorneys, and medical providers.

Preferred

• Bachelor's degree in a related field.
• Proficiency with Microsoft Word and Excel.

Why This Opportunity

• Fully remote opportunity serving the San Antonio/Corpus Christi, TX region.
• Join a well-established workers' compensation organization with a collaborative claims team.
• Manage complex, meaningful claims while maintaining autonomy in your work.
• Opportunity to make a direct impact through quality claim handling and exceptional client service.
• Stable organization with long-term career growth potential.

Compensation & Benefits

• Competitive salary of $60,000–$75,000, based on experience.
• Remote work environment.
• Comprehensive benefits package.
• Paid time off and company holidays.
• Professional development and ongoing training opportunities.
• Supportive team culture with experienced leadership.

Ready to Take the Next Step?

If you're an experienced Texas Workers' Compensation Claims Examiner looking for a remote opportunity where your expertise is valued, we'd love to connect with you. Apply today to learn more about this confidential opportunity.