Workers Compensation Claims Examiner I – Irving TX

TEEMA Group; Irving (TX); Hybride; USD 50 000 - 55 000; Plein temps

Résumé du poste

TEEMA Group is seeking a Workers’ Compensation Medical-Only Claims Adjuster in Irving, Texas. The role handles medical-only claims from intake through closure, with on-site duties and hybrid options outside the DFW metroplex.

You will investigate claims, review medical billing, establish reserves within authority, and communicate with claimants, providers, and clients while adhering to guidelines. Experience with workers’ compensation laws and medical terminology is required.

Qualifications

• 1–3 years of workers’ compensation claims experience.
• Knowledge of workers’ compensation laws and medical terminology.
• Ability to evaluate claim information, medical documentation, and billing.
• Strong judgment to recognize exposure changes and seek guidance.
• Organizational skills and attention to detail; ability to meet deadlines.
• Effective written and verbal communication; state-appropriate licensure.

Responsabilités

• Manage medical-only workers’ compensation claims from intake through closure.
• Conduct timely investigations and gather information for evaluation.
• Determine compensability under state laws and guidelines; escalate when needed.
• Coordinate and monitor medical treatment and billing; authorize within authority.
• Calculate and adjust reserves within limits; maintain diaries and status notes.
• Communicate with claimants, employers, providers, vendors, clients, and staff.
• Monitor for changes in exposure, indemnity, or complexity; refer when necessary.

Connaissances

Claims experience

Regulatory knowledge

Analytical thinking

Organizational skills

Communication skills

Licensure/Certification

Formation

Bachelor's degree (nice to have)

Description du poste

Job Title:

Workers’ Compensation Medical-Only Claims Adjuster

Job ID:

90953

Location:

Irving, Texas –On-site / Hybrid if outside the DFW metroplex

Overview:

Our client is seeking a Workers’ Compensation Medical-Only Claims Adjuster to manage medical-only claims from inception through resolution. This position handles claims with total exposure up to $10,000, within assigned authority limits and established company and client guidelines. Working under close to moderate supervision, you will investigate claims, coordinate medical treatment, review billing, maintain accurate documentation, and recognize developments that require supervisory review or reassignment.

What you will be doing:

• Manage medical-only workers’ compensation claims from intake through closure.
• Conduct timely investigations and gather information needed to evaluate claims.
• Determine compensability under applicable state laws and company guidelines, seeking supervisory guidance on disputed or unusual matters.
• Coordinate and monitor medical treatment and billing, providing authorization within assigned authority.
• Calculate, establish, and adjust reserves within authority limits.
• Communicate professionally with claimants, employers, medical providers, vendors, clients, and internal staff.
• Monitor claims for lost time, potential indemnity benefits, increased medical exposure, litigation, and other changes in complexity.
• Promptly refer claims exceeding $10,000 in total exposure or the medical-only scope for supervisory review and appropriate reassignment.
• Maintain a diary system, meet deadlines, and document claim status and handling activities accurately.
• Communicate relevant injury trends and safety concerns to clients.
• Follow company procedures and client claims handling instructions, and participate in file reviews.

What you must have:

• One to three years of related claims experience, or an equivalent combination of education and experience.
• Working knowledge of workers’ compensation laws, statutory requirements, and medical terminology relevant to medical-only claims.
• Ability to evaluate claim information, medical documentation, and billing.
• Sound judgment to recognize changes in exposure or complexity and seek supervisory guidance promptly.
• Strong organizational skills, attention to detail, and ability to prioritize tasks and meet deadlines.
• Effective written and verbal communication skills.
• Any license or certification required by applicable state regulations.

Nice to have:

• Bachelor’s degree in a related field.
• Direct experience managing medical-only workers’ compensation claims.
• Proficiency in Microsoft Word and Excel. Compensation: $50,000 to $55,000

Thank you for your interest in this opportunity. If you are selected to move forward in the process, we will contact you directly. If you do not hear from us, we encourage you to continue visiting our website for other roles that may be a good fit.

For more information about TEEMA and to consider other career opportunities, please visit our website at www.teemagroup.com