Senior Workers' Comp Claims Specialist

Insurica; Marble Falls (TX); On-site; USD 75,000 - 112,000; Full time

Job summary

Insurica Marble Falls is seeking a Workers’ Compensation Claims Adjuster to manage a caseload of about 150 open claims, applying our procedures and best practices to resolve them in accordance with statutory and regulatory requirements.

You will review initial claims, interview involved parties, determine causality, calculate benefits, and monitor progress while maintaining detailed records and communicating with all stakeholders. This role supports training and mentoring within the team.

Qualifications

• 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 required.
• Spanish language skills (speak and understand) preferred, but not required.

Responsibilities

• 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 witnesses, review medical reports and accident reports to determine causality and compensability.
• Communicate with the injured worker, employer(s), medical professionals and legal representatives; provide ongoing updates to all parties involved.
• Make determinations on the approval or denial of claims; calculate benefits including medical expenses, wage replacement and other compensation.
• Manage and monitor open claims to ensure timely processing; coordinate return-to-work programs and rehabilitation services.

Skills

Workers’ compensation

Claims handling

Communication skills

Spanish language (pref)

Education

2 Year Degree

Job description

Insurica Marble Falls is seeking a Workers’ Compensation Claims Adjuster to manage a caseload of about 150 open claims, applying our procedures and best practices to resolve them in accordance with statutory and regulatory requirements.

You will review initial claims, interview involved parties, determine causality, calculate benefits, and monitor progress while maintaining detailed records and communicating with all stakeholders. This role supports training and mentoring within the team.