Workers Compensation Claims Examiner II
Dallas, TX, United States13h ago
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Key details
- Salary
- $70K–$75K/yr
- Location
- Dallas, TX, United States
- Work style
- Onsite
- Level
- Mid level
- Job type
- Full-time
- Experience
- 3–5 yrs
- Function
- Finance & Accounting
- Focus area
- other
- Posted
- 13h ago
Skills
About the role
POSITION SUMMARY: Under general supervision, manages workers’ compensation indemnity claims of moderate to complex difficulty from inception through resolution within assigned authority limits and established company and client guidelines. Exercises independent judgment in routine and complex claims handling and seek supervisory guidance on unusual, high-exposure, or sensitive matters.
DUTIES AND RESPONSIBILITIES:
- Manages a caseload of approximately 150–180 workers’ compensation claims of moderate to complex difficulty. *
- Calculates and establishes reserves and authorizes payments and settlements within assigned authority limits, which are lower than those assigned to Claims Examiner III. *
- Identifies and escalates claims involving significant exposure, unusual compensability issues, sensitive client concerns, or decisions exceeding assigned authority.*
- Refers claims to defense counsel as appropriate and monitors litigation activities, consulting with the supervisor on significant legal developments and settlement strategy.*
*Essential job function.
EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer and other office equipment.
SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire.
Qualifications
QUALIFICATIONS REQUIRED:
Education/Experience: Bachelor’s degree in related field (preferred); and three (3) to five (5) years related experience; or equivalent combination of education and experience.
Knowledge, Skills and Abilities:
- Technical knowledge of statutory regulations and medical terminology.
- Analytical skills.
- Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
- Ability to interact with people at all levels in the business environment.
- Ability to independently and effectively manage very complex claims.
- Proficient in Word and Excel (preferred).
Other Qualifications:
- Certification and/or or license as required by State regulation.
Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements]
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MENTAL AND PHYSICAL REQUIREMENTS |
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1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
Solve practical problems; variety of variables with limited standardization; interpret instructions.
X Logical or scientific thinking to solve problems; several abstract and concrete variables.
Wide range of intellectual and practical problems; comprehend most obscure concepts. |
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b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording.
Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; require theoretical application. |
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c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
X Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. |
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2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
X Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects
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