Workers Compensation Adjuster (TX)

Workers' Compensation Claims Examiner

The Workers' Compensation Claims Examiner is responsible for managing and resolving Texas workers' compensation claims while ensuring compliance with the Texas Department of InsuranceDivision of Workers' Compensation (TDI-DWC). This hybrid role is based out of the Irving, TX office and offers a blend of in-office collaboration and remote work flexibility. The examiner handles investigations, benefit administration, communication with stakeholders, and settlement strategies to drive timely, fair claim resolution.

Claims Management

• Manage a caseload of Texas WC claims from initial report through resolution.
• Conduct prompt, thorough investigations including recorded statements and employer interviews.
• Analyze medical records, wage reports, and compensability factors to determine appropriate benefits.
• Monitor treatment plans and coordinate with providers to ensure medically necessary care.

Regulatory & Compliance

• Follow all requirements under the Texas Labor Code, TDI-DWC rules, and strict timeline mandates.
• Issue timely notices, benefit payments, PLN forms, and other required documentation.
• Maintain accurate claim files and ensure compliance with internal and external audits.

Communication & Coordination

• Collaborate closely with employers, injured workers, medical providers, attorneys, and nurse case managers.
• Communicate claim status and next steps clearly and professionally.
• Support employers with return-to-work planning, including modified duty options.

Litigation & Legal Support

• Work with defense counsel on disputed claims, benefit review conferences (BRC), and contested case hearings (CCH).
• Prepare litigation summaries, evaluations, and recommendations for settlement authority.
• Attend hearings (in person or virtual) when needed.

Financial & Settlement Management

• Set and maintain accurate reserves based on exposure and medical progression.
• Evaluate settlement opportunities and negotiate within designated authority.
• Identify fraud indicators and pursue subrogation when appropriate.

Qualifications

• Experience handling Texas Workers' Compensation claims required.
• Strong knowledge of TDI-DWC rules, forms, deadlines, and dispute resolution processes.
• Excellent communication, investigative, and negotiation skills.
• Ability to work efficiently in a hybrid environment based out of Irving, TX.
• Certifications such as AIC, ARM, or WCCP preferred but not required.