Claims Examiner III

Job Description

Job Description

Claims Examiner III – Workers’ Compensation

Role Summary

The Claims Examiner III is responsible for independently managing the full lifecycle of Workers’ Compensation indemnity claims, from initial reporting through final resolution. Operating with minimal supervision, this role requires strong analytical judgment, regulatory knowledge, and a commitment to delivering timely, accurate, and compliant claim outcomes.

This position plays a critical role in supporting employers and injured employees by ensuring claims are handled with professionalism, urgency, and integrity. The ideal candidate is organized, service-oriented, and confident in navigating complex claim scenarios within established authority levels and statutory guidelines.

This is an excellent opportunity for an experienced claims professional seeking autonomy, responsibility, and meaningful impact in a structured and collaborative office environment.

Duties & Responsibilities

• Manage loss-time Workers’ Compensation claims within Texas jurisdiction from inception through closure

• Investigate, evaluate, and determine compensability in accordance with statutory regulations and internal guidelines

• Administer and issue benefit payments accurately and within required timelines

• Ensure compliance with all applicable state laws, regulatory standards, and client-specific handling instructions

• Prepare detailed, formal captioned reports that meet client documentation requirements

• Communicate effectively and professionally with clients, claimants, employers, attorneys, and internal stakeholders

• Provide exceptional customer service while assisting employers and injured employees in understanding the Workers’ Compensation process

• Maintain organized, accurate claim files and documentation

• Demonstrate strong time management and sense of urgency in claim handling

• Collaborate with management and fellow claims professionals to ensure consistent, high-quality outcomes

• Consistently maintain on-site office attendance in a timely manner to support team operations and client engagement

• other duties as assigned

Required Qualifications

• High School Diploma or GED required

• Minimum five (5) years of related Workers’ Compensation claims handling experience, or equivalent combination of education and experience

• Current Texas Workers’ Compensation Adjuster License

• Strong knowledge of Texas Workers’ Compensation statutes and indemnity claim handling

• Ability to manage claims independently with minimal supervision

• Excellent written and verbal communication skills

• Strong organizational skills and attention to detail

• Professional demeanor with a positive, team-oriented attitude

• Ability to interact effectively with clients, claimants, and internal teams

Desired Qualifications

• Bachelor’s degree in Business, Risk Management, Insurance, or related field (preferred)

• Experience handling complex or high-exposure indemnity claims

• Demonstrated ability to prepare formal client-ready reports

• Proven track record of delivering high-quality customer service

• Strong problem-solving and decision-making skills

About the Organization

This organization is a professional risk management and claims administration firm committed to delivering responsive, compliant, and high-quality claims services. The culture emphasizes accountability, collaboration, and client satisfaction while empowering employees with the autonomy and support needed to succeed.

Location & Work Type

On-site position in an office environment.

Full-time, exempt role. Regular in-office attendance is required due to the collaborative and client-facing nature of the position.