Complex Claims Adjuster Jobs (NOW HIRING)

Workers Compensation Claims Adjuster

Direct Hire - Remote

Salary: Up to $88,000 per year

About Our Client

Our client is one of the most respected third-party administrators (TPAs) in the U.S. insurance industry. With over 30 years of experience, they deliver claims management, loss control, and risk management services across workers' compensation, general liability, property, and disability lines.

Operating coast to coast with offices in major markets, our client partners with self-insured employers, captives, and carriers who demand sophisticated, outcome-driven claims handling. The Houston branch is a cornerstone of their workers' compensation operations — serving complex, high-volume clients across Texas and beyond.

Our client is known for a culture of technical excellence, compliance rigor, and genuine investment in their examiners' professional growth. This is a company where your expertise is recognized, your caseload is meaningful, and your work directly shapes client outcomes.

Why This Role Is Open — And Why It's Urgent

Our client is actively expanding their Houston WC team to meet growing client demand. This is a senior-level, individual-contributor role where you will independently manage a complex indemnity caseload from first notice of loss through closure — with the authority and trust of an experienced examiner. If you hold a Texas WC adjuster license and have 5+ years handling indemnity files, our client wants to speak with you now.

Position Summary

Under minimal supervision, the Claims Adjuster manages all aspects of indemnity workers' compensation claims handling from inception through conclusion, within established authority levels and company guidelines. This is a senior individual-contributor role requiring deep knowledge of Texas WC statute, strong investigative instincts, and the ability to independently manage a caseload of 110–150 files — including highly complex claims.

This position isa remote position for Texas candidates outside of Houston, TX and Hybrid (2 days in office) for Houston, TX candidates. Consistent, timely on-site presence is inherently required due to the significant level of interaction with clients, claimants, vendors, and internal staff.

Duties & Responsibilities

• Effectively manage a caseload of 110–150 workers' compensation files, including very complex and high-exposure indemnity claims
• Initiate and conduct thorough claim investigations in a timely manner
• Determine compensability and administer benefits consistent with Texas state law and company guidelines
• Manage medical treatment and medical billing; authorize services as appropriate
• Communicate proactively with claimants, medical providers, and vendors regarding claim status and issues
• Compute and set reserves within established company authority levels
• Maintain a disciplined diary system for case review; document files to accurately reflect status and activity
• Communicate timely, accurate claim information to clients — including injury trends and safety-related concerns
• Adhere to all company policies, procedures, and compliance requirements
• Conduct independent file reviews
• Perform other duties as assigned

Qualifications

Education & Experience

High School Diploma or GED required. Bachelor's degree in a related field preferred. A minimum of five (5) years of workers' compensation claims experience required, or an equivalent combination of education and experience. Indemnity experience is essential.

Required License

Texas Workers' Compensation Adjuster License — this is a hard requirement. Candidates without this license will not be considered.

Knowledge, Skills & Abilities

• Strong technical knowledge of Texas WC statutory regulations and medical terminology
• Analytical and investigative skills applied to complex, multi-issue claims
• Excellent written and verbal communication skills — ability to convey technical information to claimants, clients, and colleagues
• Ability to interact professionally at all levels of the business environment
• Demonstrated ability to independently manage very complex claims to resolution
• Proficiency in Microsoft Word and Excel (preferred)

If you are looking for an amazing opportunity to get into a major insurance company as an experienced adjuster with career growth opportunities, submit your resume now!