Workers Compensation Medical Only Claims Adjuster | Remote

Job Description

Job Description

Our client is seeking a Workers’ Compensation Medical Only Claims Adjuster to join their Texas team. This person will oversee and manage medical-only workers’ compensation claims, ensuring timely evaluations, appropriate medical care, and efficient claim resolutions.

This is an excellent opportunity for a claims professional who enjoys investigating workplace injuries, working closely with medical providers, and managing claims from initial reporting through closure. The ideal candidate will have a strong understanding of workers’ compensation regulations, medical billing practices, and claims administration.

Responsibilities

• Handle a caseload of medical-only workers’ compensation claims involving exposures up to $10,000.

• Investigate reported workplace injuries, gather supporting documentation, and evaluate claim eligibility.

• Review claim details to make appropriate compensability decisions in accordance with applicable workers’ compensation regulations.

• Oversee medical treatment activities, review provider invoices, and approve services within established authorization limits.

• Maintain regular communication with injured employees, employers, healthcare professionals, and other involved parties.

• Establish and update claim reserves based on medical expenses, claim developments, and anticipated exposure.

Qualifications

• 1-3 years of workers' compensation medical only or claims associate experience.

• Experience managing medical-only workers’ compensation claims preferred.

• Active Texas adjusters license

• Understanding of workers’ compensation laws, medical terminology, and applicable state regulations.

• Familiarity with medical billing, treatment coordination, compensability determinations, and claim reserving.

• Ability to evaluate medical records, investigate claims, and identify potential changes in claim exposure.

Salary & Benefits

• $50,000 - $60,000 annually (depending on experience)

• Competitive Medical, Dental and Vision plans

• Employer match 401(k)

• Paid Holidays & Paid Time off

• Advancement opportunities internally within the organization