Workers Compensation Adjuster (TX)

Position Overview

The Workers' Compensation Claims Examiner is responsible for managing and resolving Texas workers' compensation claims while ensuring compliance with the Texas Department of Insurance-Division 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.

Key Responsibilities

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.