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.
...This is why we are seeking a driven, curious, relentless, and relationship-focused problem-solver to join our team as a Sales Account Manager in our Maine or New Hampshire location. Our Sales Account Managers are responsible for growing our business with new...
...into the work we do. From day one, you'll contribute to ongoing projects and see the difference you make. We have opportunities in geology, geophysics, petrophysics, and petroleum engineering. When you apply, we'll match you to a team that suits your academic experience...
...solutions Build strong relationships in the local community Represent Solar Pros with professionalism and confidence What We're... ... Comfortable with in-person customer interaction No experience required. We train you from the ground up. Details Full...
...Aspen One is the parent company of Aspen Skiing Company, Aspen Hospitality, and Aspen Ventures. Aspen One enables the expansion of the Aspen brand and ethos globally by developing enhanced strategies and services to support growth and accelerate investment across ski...
...Join Our Team as a Mortgage Loan Assistant at Corda Credit Union! Cedar Rapids, IA Corda Credit Union values every employee and recognizes the important role each individual plays in our success. We are currently seeking a motivated and detail-oriented individual...