Medical-Only Workers' Comp Claims Examiner I

Paycom - ATS; Irving (TX); On-site; USD 33,000 - 36,000; Full time

Job summary

Paycom - ATS in the Dallas/Irving area seeks an experienced claims administrator to manage medical-only workers’ compensation claims from inception to resolution, with exposure capped at $10,000 and within supervisory guidance.

You will investigate claims, determine compensability under state laws, coordinate treatment and billing, maintain a diary system, and communicate with claimants, employers, providers, and clients.

Qualifications

• Knowledge of workers’ compensation laws and medical terminology.
• Ability to investigate and manage medical-only claims.
• Strong organizational skills and ability to meet deadlines.

Responsibilities

• Manage medical-only workers’ compensation claims up to $10,000 exposure.
• Initiate timely investigations to gather information for claim evaluation.
• Determine compensability under state laws and company guidelines.
• Coordinate and monitor medical treatment and billing, with authorization within authority.
• Maintain diaries and document claim status and handling activities.
• Communicate claim status and trends to clients and claimants.
• Refer claims exceeding exposure to supervisor for review.

Skills

Communication skills

Organizational skills

Analytical skills

Investigate claims

Education

Bachelor’s degree or equivalent

Tools

Microsoft Word

Microsoft Excel

Job description

Paycom - ATS in the Dallas/Irving area seeks an experienced claims administrator to manage medical-only workers’ compensation claims from inception to resolution, with exposure capped at $10,000 and within supervisory guidance.

You will investigate claims, determine compensability under state laws, coordinate treatment and billing, maintain a diary system, and communicate with claimants, employers, providers, and clients.