Workers Compensation Claims Adjuster - 259949

Medix Staffing Solutions, Inc.; Irving (TX); Hybrid; USD 81,000 - 99,000; Full time

Benefits offered by this job

401(k) retirement plan with company匹配

Employee Stock Purchase Plan (ESPP)

Comprehensive medical, dental, and vis

Health Savings Account (HSA) with公司贡献

PTO, holidays, and sick leave

Job summary

Medix Staffing Solutions, Inc. seeks a Senior Workers’ Compensation Claims Specialist in Irving, TX for a hybrid role requiring 1–2 days in-office. The role handles complex indemnity and litigated claims for a premier national client, with exposure across TX, OK, LA, MS, and AL.

The candidate will collaborate with client risk managers, defense counsel, and internal managed care teams to drive optimal claim outcomes and financial results.

Qualifications

• Minimum of 4+ years of dedicated experience adjudicating complex workers’ compensation claims.
• Direct, practical knowledge handling claims in Texas with exposure to Oklahoma, Louisiana, Mississippi, and/or Alabama.
• Active Texas All-Lines Adjuster License (or Texas Workers' Compensation Adjuster License) required; non-resident licenses must be active or obtained within 90 days of hire.

Responsibilities

• Initiate timely investigations to establish compensability and detect potential fraud.
• Administer claims per statutory guidelines across TX/OK/LA/MS/AL and meet reporting deadlines.
• Establish and adjust medical, indemnity, and expense reserves within delegated authority.

Skills

Workers’ comp claims

Claim adjudication

Litigation coordination

Education

Bachelor’s degree or equivalent

Job description

Location: Irving, TX (Hybrid: 1–2 days per week in-office)

Compensation: Up to $90,000 / year (based on prior experience)

Employment Type: Full-Time

About the Company:

We are a leading national third-party administrator (TPA) and risk management services organization delivering integrated claims administration, cost-containment, and managed care solutions to premier self-insured and commercial clients nationwide. We foster a collaborative, tech-forward culture with an emphasis on career growth, clinical partnership, and proactive claims resolution.

Role Overview:

The Senior Workers’ Compensation Claims Specialist is responsible for the investigation, evaluation, negotiation, and equitable resolution of complex indemnity and litigated workers’ compensation claims. This position is dedicated to a high-profile, premier national client account managing exposure across Texas, Oklahoma, Louisiana, Mississippi, and Alabama.

Working in a hybrid capacity (1–2 days per week in our Irving, TX office), you will partner directly with client risk managers, defense counsel, healthcare providers, and internal managed care resources to drive optimal claim outcomes.

• Investigation & Compensability: Initiate timely three-point contact (injured employee, employer, medical provider) upon notice of loss. Perform thorough fact-finding investigations to establish compensability, identify potential fraud, evaluate subrogation/recovery potential, and issue timely statutory notices.
• Jurisdictional Compliance: Administer claims in strict adherence to statutory guidelines, administrative rules, mandatory reporting deadlines, dispute resolution procedures, and medical fee schedules across designated jurisdictions (TX, OK, LA, MS, and AL).
• Reserve & Financial Management: Establish, evaluate, and adjust medical, indemnity, and expense reserves on an ongoing basis to reflect ultimate exposure within delegated authority. Authorize and issue timely indemnity benefits (TTD, TPD, PPD/impairment ratings) and appropriate medical payments.
• Litigation & Settlement Strategy: Direct defense counsel in litigated files, evaluating legal exposures, controlling litigation expenses, and attending mediations, settlement conferences, or administrative hearings. Prepare comprehensive settlement evaluations and negotiate fair closures (full and final settlements, clinchers, compromise and releases).
• Integrated Managed Care Collaboration: Collaborate with internal clinical partners—including telephonic and field nurse case managers, utilization review professionals, and return-to-work specialists to optimize medical management and facilitate safe, timely modified-duty returns.
• Client Stewardship & Reporting: Serve as a trusted advisor to client risk management. Comply with account-specific Special Handling Instructions (SHIs), participate in formal file audits and stewardship reviews, and provide regular executive status reports on high-exposure claims.

Required Skills:

Experience: Minimum of 4+ years of dedicated experience adjudicating complex workers’ compensation lost-time/indemnity claims.

Multi-Jurisdiction Exposure: Direct, practical knowledge handling claims in Texas as well as exposure to adjacent regional states (Oklahoma, Louisiana, Mississippi, and/or Alabama)

Licensing: Active Texas All-Lines Adjuster License (or Texas Workers' Compensation Adjuster License) required. Adjuster licenses for designated non-resident states (OK, LA, MS, AL) must be active or obtained within 90 days of hire

Preferred Skills:

Education: Bachelor’s degree preferred, or equivalent professional work experience in casualty claims management.

Schedule/Shift:

Flex Start 7-8am, Standard 40 hour work week.

Must come into the office 1-2 times per week (This is flexible on which days and usually coordinated in advance)

Why Join Us

• Predictable Hybrid Work: A balanced, flexible schedule requiring just 1–2 collaborative days per week in our Irving, TX office with the remainder worked remotely.
• Integrated Support Infrastructure: Direct daily access to dedicated in-house nurse case managers (telephonic/field), utilization review clinicians, and medical bill review teams—eliminating administrative bottlenecks so you can focus on true claim direction.
• Dedicated Account Partnership: Adjudicate exposure for a single, premier national client rather than a disjointed roster of smaller accounts, ensuring consistent special handling guidelines and clear communication.

Total Rewards Package:

• Base salary up to $90,000, evaluated on regional experience and technical depth
• 401(k) retirement plan with company match
• Employee Stock Purchase Plan (ESPP)
• Comprehensive medical, dental, and vision health coverage
• Health Savings Account (HSA) with company contribution, plus FSA options
• Generous paid time off (PTO) accrual, company-paid holidays, and sick leave