Workers’ Compensation Medical Only Claims Examiner | San Antonio, TX

Insurance Placement Solutions (IPS) has an immediate opening for a Workers’ Compensation Medical Only Claims Examiner with our client in San Antonio, Texas. This is a full-time, temp-to-hire opportunity with a hybrid work arrangement. Candidates must have at least one year of related claims experience and a current Texas adjuster license. The position focuses exclusively on workers’ compensation medical-only claims.

In this role, you’ll manage a caseload of approximately 150 to 180 medical-only workers’ compensation claims from initial investigation through resolution. You’ll determine compensability, coordinate medical treatment, review medical billing, establish reserves, and communicate with claimants, medical providers, and clients while ensuring compliance with Texas workers’ compensation regulations and established claims-handling guidelines.

Workers’ Compensation Medical Only Claims Examiner Responsibilities

• Manage a caseload of approximately 150 to 180 workers’ compensation medical-only claims
• Initiate and conduct timely claim investigations to determine compensability
• Administer medical benefits in accordance with Texas workers’ compensation regulations and established guidelines
• Coordinate medical treatment and authorize services within designated authority
• Review and manage medical billing associated with assigned claims
• Establish and maintain appropriate claim reserves
• Communicate with injured workers, medical providers, vendors, and clients regarding claim status and developments
• Maintain accurate claim documentation and timely diary management
• Identify and communicate injury trends or potential safety concerns to clients and internal stakeholders
• Coordinate with loss control personnel when appropriate
• Participate in claim file reviews and collaborate with supervisors and other claims professionals
• Ensure compliance with company policies, claims-handling standards, and applicable regulatory requirements

Qualifications

• Minimum of 1 year of related claims handling experience or an equivalent combination of education and experience
• Knowledge of workers’ compensation statutory regulations and medical terminology
• Ability to investigate claims, evaluate compensability, and manage medical benefits
• Strong analytical, organizational, and problem-solving skills
• Excellent written and verbal communication skills
• Ability to communicate effectively with claimants, clients, medical providers, and internal staff
• Ability to manage multiple claim files while maintaining accuracy and meeting deadlines

Preferred

• Experience handling Texas workers’ compensation medical-only claims

Licensing & Certifications

• Current Texas adjuster license required

About Insurance Placement Solutions

Insurance Placement Solutions is a staffing and recruiting firm specializing in the insurance industry. We connect talented professionals with temporary, temp-to-hire, and direct-hire opportunities at leading insurance organizations across the United States.

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