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

Company Information

Our client is a leading national third-party administrator (TPA) and risk management services organization delivering integrated claims administration, cost-containment, and managed care solutions to premier self-insured and commercial clients nationwide. They foster a collaborative, tech-forward culture with an emphasis on career growth, clinical partnership, and proactive claims resolution.

This position operates on a hybrid schedule, requiring 1–2 days per week in the office in Irving TX, with the remaining days worked remotely. Scheduling for in-office days is flexible and coordinated in advance. The role entails a standard 40-hour work week with flexible start times between 7-8 AM.

Job Summary

Our client is seeking a Claims Adjuster responsible for the investigation, evaluation, negotiation, and equitable resolution of complex indemnity and litigated workers’ compensation claims. This position is dedicated to a high-profile, premier national client account, managing exposure across multiple jurisdictions. This role offers a predictable hybrid work schedule, requiring 1–2 collaborative days per week in the office with the remainder worked remotely.

Key Responsibilities

• Investigation & Compensability: Initiate timely three-point contact (injured employee, employer, medical provider) upon notice of loss. Perform thorough fact-finding investigations to establish compensability, identify potential fraud, evaluate subrogation/recovery potential, and issue timely statutory notices.
• Jurisdictional Compliance: Administer claims in strict adherence to statutory guidelines, administrative rules, mandatory reporting deadlines, dispute resolution procedures, and medical fee schedules across designated jurisdictions.
• Reserve & Financial Management: Establish, evaluate, and adjust medical, indemnity, and expense reserves on an ongoing basis to reflect ultimate exposure within delegated authority. Authorize and issue timely indemnity benefits (TTD, TPD, PPD/impairment ratings) and appropriate medical payments.
• Litigation & Settlement Strategy: Direct defense counsel in litigated files, evaluating legal exposures, controlling litigation expenses, and attending mediations, settlement conferences, or administrative hearings. Prepare comprehensive settlement evaluations and negotiate fair closures (full and final settlements, clinchers, compromise and releases).
• Integrated Managed Care Collaboration: Collaborate with internal clinical partners—including telephonic and field nurse case managers, utilization review professionals, and return-to-work specialists—to optimize medical management and facilitate safe, timely modified-duty returns.
• Client Stewardship & Reporting: Serve as a trusted advisor to client risk management. Comply with account-specific Special Handling Instructions (SHIs), participate in formal file audits and stewardship reviews, and provide regular executive status reports on high-exposure claims.

Qualifications

• Direct, practical knowledge handling claims in specific regions, with exposure to various state regulations.
• Active All-Lines Adjuster License required. Adjuster licenses for additional non-resident states must be active or obtained within 90 days of hire.

Experience

• Minimum of 4+ years of dedicated experience adjudicating complex workers’ compensation lost-time/indemnity claims.

Education

• Bachelor’s degree preferred, or equivalent professional work experience in casualty claims management.

 

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).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*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