Workers’ Compensation Medical Only Claims Adjuster | Remote

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

Remote Skills: Billing, Claims Management, Claims Processing, Healthcare, Healthcare Providers, Medical Billing, Medical Records, Medical Terminology, Medical Treatment, Patient Care, Regulations, Reporting Skills, State Laws and Regulations, Time Management, Worker's Compensation King'S Insurance Staffing