Job Description
Please read the requirements of this job before applying.The mandatory requirement for this opportunity is 5 years experience in handling workers' comp desk claims in Texas.A valid Texas public adjuster license is required; licenses and experience in other states are a plus especially Colorado.CORE COMPETENCIES:We are seeking a skilled and experienced professional to adjust Texas workers' compensation claims for our programs and clients.This opportunity is local to Dallas, Texas or may be fully remote.The ideal candidate is a seasoned professional that knows how to investigate, evaluate and resolve workers' compensation claims within authority.Includes the investigation and evaluation of compensability, medical and lost time claims, and the setting of proper reserves in accordance with authority.The candidate will have proven experience and be self-sufficient in their ability to manage complex workers' compensation claims including thorough investigation with injured workers, insured, medical providers, and witnesses.The candidate will be responsible for all aspects of their claims to ensure correct compensability, reserving, and resolution is realized through individual direction and vendor usage, while adhering to company and carrier guidelines.Qualifications: Must have at least 5 years of experience with an ideal candidate having 7 or more years in the management and adjusting of workers' compensation claims. Self-starter and the ability to work independently consistent with experience level, with little supervision and direction. Thorough understanding of state laws, principles of compensability, medical and insurance industry in general. Proven ability to build lasting inter-personal relationships and develop credibility with clients, brokers and carriers based on technical claim knowledge.ESSENTIAL FUNCTIONS AND Responsibilities: Exercises proper judgment and decision making to investigate and analyze claim injuries and exposures, determine the compensability, proper course of action and resolution of each claim. Oversee the handling of all aspects of the claims assigned within authority, including investigation, reserving, documentation, evaluation, medical management, negotiation and settlement. Experience and skills to manage complex litigation, compensability, and medical issues. Work with clients and carrier partners in a team approach to achieve best possible outcomes within authority and reporting requirements. Establish claim reserves based on the most likely outcome of a claim with the known facts and investigation utilizing company standards and experience. Utilize all available medical management tools and partners to ensure each injured worker attains the best possible outcome through authorization of appropriate treatment plans and accurate billing. Partner with internal and external legal counsel on litigated or questionable cases.Build strong relationships while ensuring sound legal plans are executed within jurisdictional requirements and financial accountability. Proactively handle claims with consistent documentation and execution of agreed-upon action plans and strategy. Demonstrate critical thinking and decision-making skills, to oversee, manage and direct claim processes in a fast-paced environment, while maintaining effective and professional relationships with all stakeholders. Meet claim handling quality and service standards with timely reporting and presentation of claims to clients, carriers and reinsurers. Other tasks as assigned by claims management.THE COMPANY:Innovative Risk Management is a subsidiary of Brown & Brown Insurance.Located in Dallas, Texas Innovative Risk Management was founded in 1991 and is recognized as one of the top program managers in the country, providing agents, brokers, and self-insured entities with captive and alternative risk solutions.We are at the forefront of the development and management of captives and alternative risk programs.Innovative Risk Management provides a range of captive insurance solutions, designed to give participants control over their risk management and insurance programs.Our captives are tailored to meet the unique needs of each business, bringing preferred risks together into a shared alternative risk vehicle.This approach helps reduce long-term risk costs while safeguarding resources and profits.Our solutions are segmented by premium size and business class, intended for companies with premiums ranging from $250,000 to several million in three-line casualty products:workers' compensation, general liability and auto liability.Innovative Risk Management also offers loss control and claims administration services to insurers, public entities, and self-insured organizations.Recognized as one of the Best Places to Work by our employees, Innovative Risk Management provides a collaborative environment for those seeking considerable career growth and making an impact on the future.You have a c