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Essential Duties and Responsibilities

• Manage complex workers’ compensation claims involving high financial exposure, sensitive issues, or extended life cycles.
• Investigate coverage and compensability, ensuring thorough documentation and compliance with state statutes.
• Oversee advanced medical case management, including coordination with Nurse Case Managers and external vendors.
• Develop and implement Return-to-Work plans for high-risk claims, collaborating with vocational consultants and legal counsel.
• Identify and investigate potential fraud and subrogation opportunities, partnering with the Special Investigation Unit.
• Establish and maintain accurate claim reserves within authority levels, ensuring timely responsiveness to changing circumstances.
• Evaluate and negotiate settlements within approved authority levels, including structured settlements and Medicare compliance.
• Collaborate with legal counsel to manage litigation and ensure adherence to MEM guidelines.
• Maintain accurate system data and prepare reports for management on high-profile claims.
• Foster cross-departmental collaboration with Underwriting, Premium Consultation, and Loss Prevention.
• Provide mentorship and training to junior adjusters, supporting professional growth and team development.

 

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Qualifications

• High school diploma or equivalent required; bachelor’s degree preferred.
• Associate in Claims (AIC) designation preferred.
• Valid driver’s license required; Texas-All Lines license preferred.
• 3–5 years of claims handling experience, primarily in Workers’ Compensation. Missouri experience preferred.

 

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Company Culture and Values

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Diversity Statement

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Total Rewards Overview

• Health Plans: Medical, Dental, and Vision
  Includes fertility benefits, fully paid preventative care, and adult orthodontia.
• Employer-Paid Life and Disability Benefits:
  Life Insurance (3x base salary), AD&D, Short and Long-term Disability.
• Wellness and Recognition Program: Employer-paid incentives for employees and spouses.
• Flexible Spending Account and Dependent Care options
• Health Savings Account: Generous employer contribution.
• Time Away from Work:
  Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave.
• Employee Assistance Programs
• 401k Retirement Plan: Employer match and profit sharing.
• Adoption Assistance and Tuition Assistance

 

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