Senior Workers’ Compensation Claims Adjuster — Remote & Mentor

INSURICA, Inc.; Marble Falls (TX); Hybrid; USD 65,000 - 90,000; Full time

Job summary

INSURICA, Inc. in Texas is seeking a Workers’ Compensation Claims Adjuster to manage a caseload of approximately 150 open claims, applying best practices and regulatory standards to resolve matters efficiently.

You will investigate claims, interview injured workers, employers, and witnesses; determine causality and compensability; calculate benefits; coordinate return-to-work programs; and maintain precise records while mentoring junior staff to ensure compliance and quality across the team.

Qualifications

• Strong judgment and decision-making skills.
• Excellent organizational skills with attention to detail.
• Ability to communicate effectively in writing and orally.

Responsibilities

• Review initial workers’ compensation claims for accuracy and completeness.
• Investigate to determine validity and causality, interviewing employees, employers and witnesses.
• Determine approvals/denials and calculate benefits including medical expenses and wage replacement.
• Manage and monitor open claims; coordinate return-to-work programs and rehabilitation services.
• Maintain detailed records and prepare required reports to regulatory bodies.
• Identify subrogation opportunities and negotiate settlements.
• Mentor staff and ensure compliance with workers’ compensation laws.

Skills

Judgment

Decision-making

Communication

Interpersonal skills

Organizational skills

Education

Texas Workers’ Compensation Adjuster License

All-Lines Adjuster License

Tools

EDI knowledge

Job description

INSURICA, Inc. in Texas is seeking a Workers’ Compensation Claims Adjuster to manage a caseload of approximately 150 open claims, applying best practices and regulatory standards to resolve matters efficiently.

You will investigate claims, interview injured workers, employers, and witnesses; determine causality and compensability; calculate benefits; coordinate return-to-work programs; and maintain precise records while mentoring junior staff to ensure compliance and quality across the team.