claims examiner iii

claims specialist

worker's comp/claims examiner iii Jobs in Irving

worker's comp/claims examiner iii

workers compensation claims examiner iii Jobs in Irving

workers compensation claims examiner iii

claims adjuster

TEEMA Group

<div>Claims Examiner III &ndash; Workers&rsquo; Compensation
Role Summary
The Claims Examiner III is responsible for independently managing the full lifecycle of Workers&rsquo; Compensation indemnity claims, from initial reporting through final resolution. Operating with minimal supervision, this role requires strong analytical judgment, regulatory knowledge, and a commitment to delivering timely, accurate, and compliant claim outcomes.
This position plays a critical role in supporting employers and injured employees by ensuring claims are handled with professionalism, urgency, and integrity. The ideal candidate is organized, service-oriented, and confident in navigating complex claim scenarios within established authority levels and statutory guidelines.
This is an excellent opportunity for an experienced claims professional seeking autonomy, responsibility, and meaningful impact in a structured and collaborative office environment.
Duties &amp; Responsibilities<ul><li>
Manage loss-time Workers&rsquo; Compensation claims within Texas jurisdiction from inception through closure</li><li>
Investigate, evaluate, and determine compensability in accordance with statutory regulations and internal guidelines</li><li>
Administer and issue benefit payments accurately and within required timelines</li><li>
Ensure compliance with all applicable state laws, regulatory standards, and client-specific handling instructions</li><li>
Prepare detailed, formal captioned reports that meet client documentation requirements</li><li>
Communicate effectively and professionally with clients, claimants, employers, attorneys, and internal stakeholders</li><li>
Provide exceptional customer service while assisting employers and injured employees in understanding the Workers&rsquo; Compensation process</li><li>
Maintain organized, accurate claim files and documentation</li><li>
Demonstrate strong time management and sense of urgency in claim handling</li><li>
Collaborate with management and fellow claims professionals to ensure consistent, high-quality outcomes</li><li>
Consistently maintain on-site office attendance in a timely manner to support team operations and client engagement</li><li>
other duties as assigned</li></ul>
Required Qualifications<ul><li>
High School Diploma or GED required</li><li>
Minimum five (5) years of related Workers&rsquo; Compensation claims handling experience, or equivalent combination of education and experience</li><li>
Current Texas Workers&rsquo; Compensation Adjuster License</li><li>
Strong knowledge of Texas Workers&rsquo; Compensation statutes and indemnity claim handling</li><li>
Ability to manage claims independently with minimal supervision</li><li>
Excellent written and verbal communication skills</li><li>
Strong organizational skills and attention to detail</li><li>
Professional demeanor with a positive, team-oriented attitude</li><li>
Ability to interact effectively with clients, claimants, and internal teams</li></ul>
Desired Qualifications<ul><li>
Bachelor&rsquo;s degree in Business, Risk Management, Insurance, or related field (preferred)</li><li>
Experience handling complex or high-exposure indemnity claims</li><li>
Demonstrated ability to prepare formal client-ready reports</li><li>
Proven track record of delivering high-quality customer service</li><li>
Strong problem-solving and decision-making skills</li></ul>
About the Organization
This organization is a professional risk management and claims administration firm committed to delivering responsive, compliant, and high-quality claims services. The culture emphasizes accountability, collaboration, and client satisfaction while empowering employees with the autonomy and support needed to succeed.
Location &amp; Work Type
On-site position in an office environment.
Full-time, exempt role. Regular in-office attendance is required due to the collaborative and client-facing nature of the position.
#Workwolf</div>

Claims Examiner III

CHRISTUS Health

<div>Description 
Summary:
The associate is responsible for the duties and services that are of a support nature to the Revenue Cycle division of CHRISTUS Health. The associate ensures that all processes are performed in a timely and efficient manner. The primary purpose of these positions is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The Job works in a cooperative team environment to provide value to internal and external customers.
 
The associate carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of CHRISTUS Health, and fully supports CHRISTUS Health's Mission, Philosophy, and core values of Dignity, Integrity, Compassion, Excellence and Stewardship.
Responsibilities: 
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
</li><li>Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics.
</li><li>Ensures PFS departmental quality and productivity standards are met.
</li><li>Collects and provides patient and payor information to facilitate account resolution.
</li><li>Maintains an active working knowledge of all Government Mandated Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission.
</li><li>Responds to all types of account inquires through written, verbal, or electronic correspondence.
</li><li>Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within the Revenue Cycle.
</li><li>Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
</li><li>Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
</li><li>Compliant with all CHRISTUS Health, payer, and government regulations.
</li><li>Exhibits a strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
</li><li>Appropriately documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
</li><li>Provide continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
</li><li>Professional and effective written and verbal communication required.
</li></ul><ul><li>Billing
</li><li>Review and work on claim edits.
</li><li>Works payor rejected claims for resubmission.
</li><li>Works reports and billing requests.
</li><li>Demonstrates strong knowledge of standard bill forms and filing requirements.
</li><li>Exhibits and understanding of electronic claims editing and submission capabilities.
</li><li>Correct claims in RTP status in the designated claim system per Medicare guidelines.
</li><li>Maintains an active knowledge of all governmental agency requirements and updates.
</li></ul><ul><li>Collections
</li><li>Collect balances due from payors ensuring proper reimbursement for all services.
</li><li>Identifies and forwards proper account denial information to the designated departmental liaison. Dedicated efforts to ensure a proper denial resolution and timely turnaround.
</li><li>Maintain an active knowledge of all governmental agency requirements and updates.
</li><li>Works collector queue daily utilizing appropriate collection system and reports.
</li><li>Demonstrates knowledge of standard bill forms and filing requirements.
</li><li>Identify and resolve underpayments with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and resolve credit balances with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and communicate trends impacting account resolution.
</li><li>Corrects claims in RTP status in the designated claim system per Medicare guidelines.
</li><li>Initiates Medicare Redetermination, Reopening and/or Reconsideration as needed.
</li><li>Working knowledge of the CMS 838 credit balance report.
</li></ul><ul><li>Vendor Coordinator
</li><li>Acts as liaison between external vendors and Revenue Cycle departments to monitor external vendor activities and ensures accounts placed for collection are received timely and acknowledged as received by the vendor.
</li><li>Manages account transfers between CHRISTUS Health and the various contracted vendors.
</li><li>Coordinates with Revenue Cycle Managers (Collections, Billing, Cash Applications, etc.) to review of selected accounts prior to transfer and placement with an external third party.
</li><li>Ensures accounts deemed as closed or uncollectible by the vendors are properly reflected in applicable AR systems.
</li><li>Maintains department reports measuring agency performance, which includes account placements, collections, returns, and performance metrics.
</li><li>Advises vendors of CHRISTUS Health billing and collection procedures and ensures accounts identified with third-party coverage are properly billed by the entities as requested by the vendor.
</li><li>Audits all vendor remittances and ensures all fees billed to CHRISTUS Health are in accordance with the contract and include supporting documentation of payments posted to the account on the patient accounting systems.
</li><li>Recalls accounts incorrectly placed and/or as requested by Revenue Cycle Managers with the external vendor and returns accounts to open receivables as appropriate.
</li><li>Creates tools, reports, or documentation that enables Revenue Cycle Leadership to understand, manage, and measure their vendor's performance and to prioritize important relationships.
</li><li>Performs account reconciliation between CHRISTUS Health system and vendor system.</li></ul>
Job Requirements: 
Education/Skills
<ul><li>HS Diploma or equivalent years of experience required.
</li><li>Post HS education preferred.
</li></ul>Experience
<ul><li>1-3 years of experience preferred.
</li><li>Experience working within a multi-facility hospital business office environment preferred.
</li><li>College education, previous Insurance Company claims experience, and/or health care billing trade school education may be considered in lieu of formal hospital experience.
</li><li>Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.
</li><li>Experience with Medicare &amp; Medicaid billing processes and regulations preferred.
</li><li>Understanding of Medicare language.
</li><li>Knowledge in locating and referencing CMS and/or Medicare Regulations preferred.
</li></ul>Licenses, Registrations, or Certifications
<ul><li>None required.</li></ul> 

Work Schedule: 
8AM - 5PM Monday-Friday
Work Type: 
Full Time</div>

Patient Financial Specialist - Patient Financial Services

<div>Description 
Summary:
The associate is responsible for the duties and services that are of a support nature to the Revenue Cycle division of CHRISTUS Health. The associate ensures that all processes are performed in a timely and efficient manner. The primary purpose of this Job is to ensure account resolution and reconciliation of outstanding balances for CHRISTUS Health patient accounts. The Job works in a cooperative team environment to provide value to internal and external customers.
 
The associate carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of CHRISTUS Health, and fully supports CHRISTUS Health's Mission, Philosophy, and core values of Dignity, Integrity, Compassion, Excellence, and Stewardship.
Responsibilities: 
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
</li><li>Performs Revenue Cycle functions in a manner that meets or exceeds CHRISTUS Health's key performance metrics.
</li><li>Ensures PFS departmental quality and productivity standards are met.
</li><li>Collects and provides patient and payor information to facilitate account resolution.
</li><li>Responds to all types of account inquiries through written, verbal, or electronic correspondence.
</li><li>Maintains payor-specific knowledge of insurance and self-pay billing and follow-up guidelines and regulations for third-party payers. Maintains working knowledge of all functions within the Revenue Cycle.
</li><li>Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding questions for account resolution.
</li><li>Meets or exceeds customer expectations and requirements, and gains customer trust and respect.
</li><li>Compliant with all CHRISTUS Health, payer, and government regulations.
</li><li>Exhibits a strong working knowledge of CPT, HCPCS, and ICD-10 coding regulations and guidelines.
</li><li>Appropriately documents patient accounting host system or other systems utilized by PFS in accordance with policy and procedures.
</li><li>Provide continuous updates and information to the PFS Leadership Team regarding errors, issues, and trends related to activities affecting productivity, reimbursement, payment delays, and/or patient experience.
</li><li>Must have professional and effective written and verbal communication.
</li></ul><ul><li>Billing
</li><li>Review and work on claim edits.
</li><li>Works payor rejected claims for resubmission.
</li><li>Works reports and billing requests.
</li><li>Demonstrates strong knowledge of standard bill forms and filing requirements.
</li><li>Exhibits and understanding of electronic claims editing and submission capabilities.
</li></ul><ul><li>Collections
</li><li>Collect balances due from payors ensuring proper reimbursement for all services.
</li><li>Identifies and forwards proper account denial information to the designated departmental liaison. Dedicated efforts to ensure a proper denial resolution and timely turnaround.
</li><li>Maintain an active knowledge of all collection requirements by payors.
</li><li>Works collector queue daily utilizing appropriate collection system and reports.
</li><li>Demonstrates knowledge of standard bill forms and filing requirements.
</li><li>Identify and resolve underpayments with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and resolve credit balances with the appropriate follow-up activities within payor timely guidelines.
</li><li>Identify and communicate trends impacting account resolution.
</li></ul><ul><li>Cash Reconciliation
</li><li>Ensures all payments are retrieved and posted accurately and timely through reconciliation of patient accounting system and bank statement.
</li><li>Researches submitted cash payments by verifying patient account numbers and appropriate facilities.
</li><li>Monitor and performs cash reconciliation to identify cash posting errors and ensures all receipts are applied and reconciles to daily bank deposit and monthly bank statements.
</li><li>Review and post cash corrections, including resolving patient complaints and inquiries from PFS, Finance, Facilities, and Vendor Partners.
</li><li>Resolve and Research unapplied cash, including continuous follow-up until payment identification is made for application of payment or refund.</li></ul>
Job Requirements: 
Education/Skills
<ul><li>HS Diploma or equivalent years of experience required.
</li><li>Post HS education preferred.
</li></ul>Experience
<ul><li>3-5 years of experience preferred.
</li><li>Experience working within a multi-facility hospital business office environment preferred.
</li><li>College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
</li><li>Experience working with inpatient and outpatient billing requirements of UB-04 and HCFA 1500 billing forms preferred.
</li></ul>Licenses, Registrations, or Certifications
<ul><li>None required.</li></ul> 

Work Schedule: 
8AM - 5PM Monday-Friday
Work Type: 
Full Time</div>

Patient Financial Representative Senior - Patient Financial Services

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Claims Examiner III

Patient Financial Specialist - Patient Financial Services

Patient Financial Representative Senior - Patient Financial Services