Workers Compensation Adjuster (TX)

divh2Workers Compensation Claims Examiner/h2pThe 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./ph3Claims Management/h3ulliManage a caseload of Texas WC claims from initial report through resolution./liliConduct prompt, thorough investigations including recorded statements and employer interviews./liliAnalyze medical records, wage reports, and compensability factors to determine appropriate benefits./liliMonitor treatment plans and coordinate with providers to ensure medically necessary care./li/ulh3Regulatory Compliance/h3ulliFollow all requirements under the Texas Labor Code, TDI-DWC rules, and strict timeline mandates./liliIssue timely notices, benefit payments, PLN forms, and other required documentation./liliMaintain accurate claim files and ensure compliance with internal and external audits./li/ulh3Communication Coordination/h3ulliCollaborate closely with employers, injured workers, medical providers, attorneys, and nurse case managers./liliCommunicate claim status and next steps clearly and professionally./liliSupport employers with return-to-work planning, including modified duty options./li/ulh3Litigation Legal Support/h3ulliWork with defense counsel on disputed claims, benefit review conferences (BRC), and contested case hearings (CCH)./liliPrepare litigation summaries, evaluations, and recommendations for settlement authority./liliAttend hearings (in person or virtual) when needed./li/ulh3Financial Settlement Management/h3ulliSet and maintain accurate reserves based on exposure and medical progression./liliEvaluate settlement opportunities and negotiate within designated authority./liliIdentify fraud indicators and pursue subrogation when appropriate./li/ulh3Qualifications/h3ulliExperience handling Texas Workers Compensation claims required./liliStrong knowledge of TDI-DWC rules, forms, deadlines, and dispute resolution processes./liliExcellent communication, investigative, and negotiation skills./liliAbility to work efficiently in a hybrid environment based out of Irving, TX./liliCertifications such as AIC, ARM, or WCCP preferred but not required./li/ul/div