Insurance Claims Adjuster - Non Subscriber
Pappas Restaurants
Houston, TX 77040
Description
Insurance Claims Adjuster - Non-Subscriber
Pappas Restaurants is seeking a detail oriented Non-Subscriber Claims Adjuster to join the Main Office based in Northwest Houston, Texas. To be successful in this role, candidates will be a licensed adjuster, have 5+ years of experience adjusting Workers Compensation or Texas Non-Subscriber claims and be fluent in Spanish. The Non-Subscriber Claims Adjuster is responsible for investigating and adjusting employee injury claims, benefit determination, wage replacement, and medical management for Texas Non-Subscriber claims.
Your Responsibilities as a Non-Subscriber Insurance Claims Adjuster will include:
- Manages Texas Non-Subscriber claims in accordance with the Pappas Injury Plan, Paptex.
- Conducts investigations, determines eligibility, and explains benefits to team members.
- Manages treatment plan including selecting specialists when needed.
- Establishes reserves based on severity of known medical treatment and future treatment plan.
- Processes medical bills through an audit process and codes / approves payment of bills. Enters data into claims system.
- Responsible for writing Benefit Determination Letters, Non-Compliance Warning Letters and Denial of benefits letters in accordance with the Paptex plan.
- Reports wage replacement eligibility to Pappas payroll department.
- Performs additional responsibilities as requested to achieve business objectives.
As a Non Subscriber Claims Adjuster, you should have:
- Licensed adjuster (All Lines or Property and Casualty)
- Bachelor’s degree in any field of study or 5 plus years of related experience in lieu of degree
- Minimum of 1 year of experience adjusting Workers Compensation or Texas Non-Subscriber claims
- Fluent in Spanish required
- Strong communication skills - ability to articulate benefit decisions in a positive manner and adjust communication to level of the listener when needed
- Strong writing skills - ability to draft denial letters citing the Paptex plan
- Experience in taking recorded statements and evaluating compensability
- Thorough investigation documentation required
- Must consistently demonstrate positive, patient, and professional attitude
- Detail oriented, self-starter and capable of working with little supervision
- Proficient in Microsoft Word and Excel
- Experience in a grocery, restaurant or hospitality setting preferred
Essential Physical Job Functions (with or without accommodation)
- Ability to perform manual data entry for up to 50% of an 8-hour workday
- Ability to sit for extended periods
- Ability to lift up to 10 pounds
- Strong communication skills and the ability to work collaboratively in a team environment
- Capable of managing multiple tasks with strong organizational and time management skills
- Ability to work effectively under pressure and prioritize multiple tasks
Americans with Disabilities Act (ADA)
Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done that will ensure an equal employment opportunity without imposing an undue hardship on the Company. Please contact teamresource@pappasrestaurants.com for assistance completing any forms or to participate in the application process.
Pappas Restaurants is an Equal Opportunity Employer.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Work Location: In person