Workers' Compensation Claims Adjuster I

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🔥 2 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

📋 Claims Specialist

👻 Ghost score 11%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Intercare Holdings Insurance Services

WebsiteLinkedInAll Job Openings

201 - 500 employees

🛡️ Insurance

Insurance • Risk Management

Intercare Holdings Insurance Services is a privately held company that specializes in workers' compensation and liability claims administration, managed care services, and risk management solutions. Known for their client care and responsive service, Intercare integrates advanced technology and has an in-house Special Investigations Unit (SIU) to handle claims efficiently and reduce fraudulent activities. Their unique approach combines the depth and capacity of a large organization with the flexibility of a smaller firm, ensuring customized risk management and cost control solutions for clients. With a strong emphasis on customer satisfaction, Intercare is a trusted partner in reducing risk and maintaining fiscal stability for their clients.

📋 Description

• Manage a caseload of medical-only workers’ compensation claims under close supervision • Conduct three-point contact with the injured worker, employer, and treating physician to initiate claims and gather facts • Investigate claims, assess compensability, evaluate mechanism of injury, and determine benefits • Escalate questionable AOE/COE claims for SIU referral when appropriate • Maintain accurate claim documentation and ensure claims remain classified as medical-only • Direct medical care throughout the claim life cycle • Object to unnecessary or unreasonable treatment • Coordinate with utilization review and medical bill review teams and follow through on determinations • Monitor injured workers’ progress toward maximum medical improvement and coordinate return-to-work outcomes • Identify claims at risk of escalating to indemnity status and flag them for supervisory review • Establish initial reserves, monitor and adjust reserves periodically • Submit 90-day carrier status reports in compliance with client and regulatory requirements • Negotiate and finalize claim settlements, including lien resolution • Identify and manage subrogation opportunities with recovery specialists

🎯 Requirements

• 1–3 years of experience as a WC Claims Assistant, Trainee, or Future Med Adjuster; OR Bachelor’s degree and a minimum of six months of WC claims experience • Active Texas Worker's Comp or all lines license required; multi-state preferred • Designation such as AIC, ARM, SIP, or WCCP a plus but not required • Familiarity with claims management platforms (e.g., Guidewire, Juris, ClaimCenter) preferred • Working knowledge of Texas WC statutes • Proficiency in Microsoft Office Suite • Ability to read and interpret medical records • Ability to conduct three-point contact with the injured worker, employer, and treating physician • Ability to assess compensability and evaluate mechanism of injury • Ability to make benefit determinations in accordance with applicable state WC statutes • Ability to maintain accurate claim documentation and classify claims as medical-only • Ability to direct medical care and coordinate utilization review and medical bill review • Ability to monitor progress toward maximum medical improvement and coordinate return-to-work outcomes • Ability to establish, monitor, and adjust reserves • Ability to submit 90-day carrier status reports • Ability to negotiate and finalize claim settlements, including lien resolution • Ability to identify and manage subrogation opportunities • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role

🏖️ Benefits

• Comprehensive medical, dental, and vision benefits • Company contributions to HSA and FSA plans • Employer paid life and disability insurance • 401(k) with company match • Paid time off (PTO) and company paid holidays • Learning and development opportunities that support real career advancement • Employee assistance resources • Supportive culture that values balance and wellbeing • Experienced mentors and clear guidance • Reasonable caseloads • Collaborative teams and expert support • Real career paths for professionals who want to grow or move into leadership