Position Overview
The Workers’ Compensation Claims Examiner is responsible for managing and resolving Texas workers’ compensation claims while ensuring compliance with the Texas Department of Insurance–Division 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.
Key Responsibilities
Claims Management
Manage a caseload of Texas WC claims from initial report through resolution.
Conduct prompt, thorough investigations including recorded statements and employer interviews.
Analyze medical records, wage reports, and compensability factors to determine appropriate benefits.
Monitor treatment plans and coordinate with providers to ensure medically necessary care.
Regulatory & Compliance
Follow all requirements under the Texas Labor Code , TDI-DWC rules , and strict timeline mandates.
Issue timely notices, benefit payments, PLN forms, and other required documentation.
Maintain accurate claim files and ensure compliance with internal and external audits.
Communication & Coordination
Collaborate closely with employers, injured workers, medical providers, attorneys, and nurse case managers.
Communicate claim status and next steps clearly and professionally.
Support employers with return-to-work planning, including modified duty options.
Litigation & Legal Support
Work with defense counsel on disputed claims, benefit review conferences (BRC), and contested case hearings (CCH).
Prepare litigation summaries, evaluations, and recommendations for settlement authority.
Attend hearings (in person or virtual) when needed.
Financial & Settlement Management
Set and maintain accurate reserves based on exposure and medical progression.
Evaluate settlement opportunities and negotiate within designated authority.
Identify fraud indicators and pursue subrogation when appropriate.
Qualifications
Experience handling Texas Workers’ Compensation claims required.
Strong knowledge of TDI-DWC rules, forms, deadlines, and dispute resolution processes .
Excellent communication, investigative, and negotiation skills.
Ability to work efficiently in a hybrid environment based out of Irving, TX .
Certifications such as AIC, ARM, or WCCP preferred but not required.
...Job Description Join our Team! Now Hiring Assistant Managers! Flexible schedule. Previous restaurant management experience required. Hourly paid training with opportunity for advancement. Must be 18 years or older. Must have your own vehicle, insurance and good...
...About the Data Entry Research Participant position We are looking for dependable, trustworthy individuals from various work experience... ...person no more than 25 miles from your home. This is an entry level position requiring no prior experiences. The hiring company...
...Overview Iron Horse ( accelerates growth for enterprise B2B brands by uniting audience-centric storytelling, precision ABM, and AI-powered optimization. As our Head of Performance Media , you'll own the strategy and day-to-day orchestration of paid programs across...
...funwel gesmaakt wordt? Waar je kan doorgroeien, maar ook voldoende vrije tijd overhoudt voor je hobbys en je gezin? Een job bij PepsiCo Veurne, das werken voor sterke merken n er elke dag van smullen. Om ons team te versterken, zoeken we nogSuperkrakszoals jij...
...Recruitment Coordinator Elite Home Health Care Location: Buffalo Pay: $22$25 per hour Schedule: Full-Time | Care Center Based | ~20% Travel Join One of New Yorks Leading Home Care Organizations Elite Home Health Care is a licensed and trusted home...