Remote Medical Claims Processor Jobs in Tyler, TX

Claims Administrative Services, Inc (CAS) has served as a third-party administrator handling workers' compensation and property and casualty claims for a wide array of clients since 1990. In addition to our claims experience, CAS offers safety and loss control, cost containment services, and program administration. Every day our experienced professionals are on the job, reducing the frequency and severity of workplace injuries, managing associated claims costs, and helping injured employees return to work. Our personalized customer service combined with dedicated experience, innovation, and cost efficiency, assists our clients in reducing costs and protecting their employees.

Heartland Security Insurance Group is the holding company for Claims Administrative Services, Inc. Heartland is comprised of seven different insurance and risk management businesses, providing products and services globally. Each of the companies offer solutions to distinct client groups in the federal, state and private sectors. The organization has been under continuous private family ownership for 50 years. Today, it has over 60 stockholders as well as ESOP ownership. In addition to providing an important retirement benefit to associates, the Employee Stock Ownership Plan (ESOP) assures that everyone in the organization has a vested interest in providing the very highest level of service to the client.

Claims Administrative Services, Inc., and the parent organization, Heartland Security Insurance Group, have a long history of philanthropy to the local, national, and international communities.

Workers' Compensation Claims Representative

The Claims Representative will manage an assigned caseload of medical only and lost time Workers’ Compensation claims from the first report of injury to resolution according to the applicable law. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. The Claims Representative will adjudicate medical only and lost time Workers' Compensation files according to applicable law.

Manage assigned caseload of workers’ compensation claims.

Make decisions about compensability, set reserves and negotiate settlements.

Interact with claimants, clients, medical providers and other third party representatives throughout the claims process.

Timely initial contacts and investigation of new claims.

Verify coverage.

Take recorded statements as needed.

Document files daily on every conversation and action taken.

Identify and address subrogation issues.

Start and stop indemnity benefits timely and accurately.

Complete jurisdictional forms timely and accurately.

Monitor ongoing medical treatment.

Request second medical opinions as needed.

Request surveillance appropriately.

Work mail and diary on a daily basis.

Client visits as required.

Preparation and handling of hearings

Communicates directly with client.

Prepares reports and other analytical data as requested by the management team.

Must hold a valid Workers’ Compensation Adjuster license.

Must have at least 2-3 years of experience handling indemnity workers’ compensation claims.

High school diploma.

Ability to follow instructions, procedures and rules.

Must have strong attention to detail.

Must have good written and oral communication skills.

Must be well organized and the ability to multi-task.

Basic computer skills in MS Word, Excel and Outlook.

Fast, accurate data entry

College degree in business or other related discipline.