Senior Workers' Compensation Claims Investigator

externalpmacompanies; Plano (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

externalpmacompanies is seeking a claims professional to independently investigate, evaluate and resolve high-complexity workers' compensation claims in Texas. The role focuses on timely decisions, reserves, and settlements with strong attention to regulatory requirements.

The candidate should have a bachelor's degree or equivalent insurance experience, familiarity with medical terminology, and the ability to travel up to 10% for state-specific needs.

Qualifications

• Bachelor's degree or equivalent work experience in insurance required (TX experience preferred).
• Experience handling claims in AR, OK, CO, and LA or willingness to learn jurisdictions.
• Familiarity with medical terminology and workers' compensation regulations is preferred.

Responsibilities

• Investigate and evaluate assigned complex workers' compensation claims.
• Determine coverage and compensability, reserves, and potential subrogation opportunities.
• Negotiate settlements within authority and coordinate with medical professionals for return-to-work strategies.
• Communicate effectively with internal and external parties and maintain thorough documentation.

Skills

Critical thinking

Decision making

Communication skills

Organizational skills

Customer service

Attention to detail

Time management

MS Office

Excel

Word

Education

Bachelor's degree

AIC designation or similar

Tools

MS Office

Excel

Word

PowerPoint

Job description

externalpmacompanies is seeking a claims professional to independently investigate, evaluate and resolve high-complexity workers' compensation claims in Texas. The role focuses on timely decisions, reserves, and settlements with strong attention to regulatory requirements.

The candidate should have a bachelor's degree or equivalent insurance experience, familiarity with medical terminology, and the ability to travel up to 10% for state-specific needs.