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.
...com is hiring an assistant e-commerce and email marketing coordinator to help with its... ...collaboration, creativity, and a healthy work-life balance. Job Summary: Excited... ...customers by responding to general inquiries, processing orders, and providing customer service...
...Were hiring a full-time, entry-level SEO Specialist in Latin America. This is a long-term role, not a short freelance gig. You do not need expert SEO experience. We will train you using clear SOPs and checklists. What matters most is reliability, honesty, and following...
...Our client, a large family practice , is hiring multiple Physician Assistants to join their organization at one of several locations.... ...experience in a family practice setting. Experience with telemedicine is a plus. Performance Skills: Strong clinical assessment...
...with Intellectual and/or Developmental Disabilities (IDD)in their home and in the community. The Complex Needs LEC will strive to motivate and encourage clients personal growth, and aid them with following their therapists Treatment Plan to help the clients transition...
...industries. As part of our continued growth, we are seeking a technically proficient and highly motivated Regional Sales Manager (RSM) to drive municipal wastewater pump and grinder sales throughout the west territories . Position Summary The Regional Sales...