Texas Workers' Compensation / Non-Subscriber Adjuster
Introduction to Davies North America
Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors. Our commitment to excellence has positioned us as a leader in our field, and we’re now seeking a highly skilled and dedicated Texas Workers' Compensation / Non-Subscriber Adjuster to join our team.
About the Role
We're on the lookout for a talented and experienced Texas Workers’ Compensation / Non-Subscriber Adjuster to investigate and manage Workers' Compensation and Texas Non-Subscriber claims for self-insured political subdivisions and Texas Non-Subscriber employers. As a key member of our team, you will play a critical role in ensuring that claims are handled efficiently, effectively, and in accordance with relevant laws and regulations. This is a full-time, home-based position that offers the opportunity to work remotely and occasionally travel to clients for quarterly claims review meetings.
Key Responsibilities
- Conduct initial three-point contact claims investigation to determine compensability
- Pay benefits in accordance with the WC Statute and/or employers’ ERISA plan document
- Work in conjunction with the client and business partners to keep them informed as claims develop
- Maintain contact with the injured employee, medical provider, and employer to facilitate return to work
- Monitor ongoing medical reports and treatment plans to manage the claim and set reserves accordingly
- Review, approve, and manage medical treatment
- Review and approve medical bills for adjudication in the Mitchell bill CEP system
- Support claim positions before legal proceedings by producing information, reports, and other documents as supportive evidence
Your Expertise, Skills, and Abilities
To be successful in this role, you will need to possess a strong foundation in Texas Workers' Compensation and Non-Subscriber claims adjustment, as well as excellent communication, organizational, and analytical skills. Specifically, we’re looking for:
- 5 years of experience adjusting Texas Workers’ Compensation and Non-Subscriber claims
- Texas Workers’ Compensation Adjuster’s license
- Technical Workers’ Compensation claims and medical terminology knowledge
- Excellent verbal and written communication skills
- Proficient with the use of computers and Microsoft Office Suite
- Exceptional organization and time management skills
- Demonstrated ability to gather, analyze, and interpret information
Essential Qualifications
In addition to the skills and experience listed above, the ideal candidate will also possess:
- A strong understanding of Texas Workers' Compensation laws and regulations
- Experience working with self-insured political subdivisions and Texas Non-Subscriber employers
- Knowledge of medical terminology and procedures
- Ability to work independently and as part of a team
- Strong problem-solving and analytical skills
Preferred Qualifications
While not required, the following qualifications are preferred:
- Certification as a Workers' Compensation Claims Adjuster
- Experience working with claims management software
- Knowledge of ERISA plan documents and procedures
- Bachelor’s degree in a related field