Workers Compensation Claims Examiner III

Workers Compensation Claims Examiner III

Hybrid Dallas - Irving, TX 75038

Salary Range $80,000.00 - $85,000.00 Salary/year Level Experienced Position Type Full Time Job Shift Day Education Level High School Diploma or GED Travel Percentage None Category Admin - Clerical

Workers' Compensation CE III

POSITION SUMMARY: Under minimal supervision, independently manages highly complex workers' compensation indemnity claims, including litigated and high-exposure claims in the Texas jurisdiction, from inception through resolution. Applies advanced technical knowledge and judgment to develop claims strategies, resolve difficult issues, and make decisions within higher assigned authority limits and established company and client guidelines.

DUTIES AND RESPONSIBILITIES:

• Manages a caseload of approximately 125150 workers' compensation claims, with an emphasis on highly complex, litigated, and high-exposure indemnity claims.
• Evaluates difficult compensability, medical, disability, and litigation issues and develops appropriate claims resolution strategies.
• Establishes and adjusts reserves and authorizes payments and settlements within assigned authority limits, which are higher than those assigned to Claims Examiner II.
• Directs defense counsel and evaluates litigation strategy, significant legal developments, and settlement recommendations.
• Prepares detailed captioned reports addressing claim status, exposure, reserves, litigation strategy, and recommended resolution.
• Escalates matters exceeding assigned authority or requiring management involvement.
• Provides technical guidance to less experienced Claims Examiners as assigned, without formal supervisory responsibility.

EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment.

SPECIAL EQUIPMENT OR CLOTHING: Follow company dress code

Qualifications

QUALIFICATIONS REQUIRED:

Education/Experience : High School Diploma or GED required; Bachelor's degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills, and Abilities:

• Advanced knowledge of Texas workers' compensation laws, regulations, and claims handling requirements.
• Ability to independently manage highly complex, litigated, and high-exposure claims with minimal supervisory guidance.
• Ability to evaluate claims exposure, develop resolution strategies, and exercise sound judgment within assigned authority.

Other Qualifications :

• Certification and/or license as required by State regulation.

MENTAL AND PHYSICAL REQUIREMENTS

1. MENTAL EFFORTa. Reasoning development:Follow one- or two-step instructions; routine, repetitive task.Carry out detailed but uninvolved written or verbal instructions; deal with a few concrete variables.Follow written, verbal, or diagrammatic instructions; several concrete variables.Solve practical problems; variety of variables with limited standardization; interpret instructions.X Logical or scientific thinking to solve problems; several abstract and concrete variables.Wide range of intellectual and practical problems; comprehend most obscure concepts.

b. Mathematical development:Simple additional and subtraction; copying figures, counting, and recording.Add, subtract, multiply, and divide whole numbers.X Arithmetic calculations involving fractions, decimals, and percentages.Arithmetic, algebraic, and geometric calculations.Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; require theoretical application.

c. Language development:Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.Ability to compose original correspondence, follow technical manuals, and have increased contact with people.X Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

2. PHYSICAL EFFORTa. Physical activity required to perform the job:X Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.Light work:a. Exerting up to 20 pounds of force occasionallyb. Exerting up to 10 pounds of force frequentlyc. Exerting a negligible amount of force constantly to move objects(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).Medium work:a. Exerting up to 50 pounds of force occasionallyb. Exerting up to 20 pounds of force frequentlyc. Exerting up to 10 pounds of force constantly to move objectsHeavy work:a. Exerting up to 100 pounds of force occasionallyb. Exerting up to 50 pounds of force frequentlyc. Exerting up to 20 pounds of force constantly to move objectsVery heavy work:a. Exerting in excess of 100 pounds of force occasionallyb. Exerting in excess of 50 pounds of force constantly to move objectsc. Exerting in excess of 20 pounds of force constantly to move objects

Visual requirements necessary to perform the job:Far vision: clarity of vision at 20 feet or moreX Near vision: clarity of vision at 20 inches or lessX Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feetDepth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually areColor vision: ability to identify and distinguish colorsField of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point

2. PHYSICAL EFFORT (cont.) - FREQUENCY

c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.Kneeling: Bending legs at knee to come to a rest on knee or knees.Crouching: Bending the body downward and forward by bending legs and spine.Crawling: Moving about on hands and knees or hands and feet.Reaching: Extending hand(s) and arm(s) in any direction.Standing: Particularly for sustained periods of time.Walking: Moving about on foot to accomplish tasks, particularly for long distances.Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.Pulling: Using the upper extremities to extend force in order to drag, haul, or tug objects in a sustained motion.FootMotion: Using feet to push pedals.Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.X Grasping: Applying pressure to an object with the fingers and palm. - FrequentlyOccasionally

X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts.Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.X Repetitive Substantial movements (motions) of the wrists, hands,Motion: and/or fingers. - FrequentlyFrequently