You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

We are seeking an experienced Claims Specialist to manage workers’ compensation claims, support injured workers, and ensure accurate, timely claim resolution. This role involves direct communication with employers, providers, and claimants, as well as detailed file documentation and medical review.

Key Responsibilities

• Review daily claim diaries and monitor claim status
• Evaluate medical reports and determine if additional opinions are needed
• Address unauthorized medical treatment as necessary
• Communicate with employers to review case details and resolve issues
• Respond to inquiries from employers, employees, providers, and attorneys
• Establish and maintain appropriate claim reserves
• Review and evaluate medical procedures, treatments, and related bills
• Collaborate with medical case managers regarding treatment plans
• Prepare and present reports to clients
• Close claims in accordance with guidelines
• Assist with client billing or payment inquiries
• Investigate complaints from injured workers
• Document and code all claim file activity accurately
• Maintain updated action plans within required timeframes
• Provide strong customer service to clients and claimants

Work Location

This role is Texas-based and offers a hybrid option depending on where you are located in Texas.

Qualifications

• 1–2 years of Texas workers’ compensation claims handling experience
• Solid understanding of TX WC laws, procedures, and medical/legal terminology
• Strong communication, documentation, and attention to detail
• Ability to evaluate medical treatment, determine compensability, and negotiate when needed
• Proficiency in Microsoft Office and comfort learning claims systems
• Strong analytical and problem-solving skills

Educational Requirements

• High School Diploma or GED
• Texas residency required (this is a Texas-specific claims role)
• Required: Texas 03 Workers’ Compensation Adjuster License
• Preferred: Texas 08 All Lines Adjuster License (not mandatory)

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients