Description
We are seeking a detail oriented Non-Subscriber Claims Adjuster to join the Pappas Restaurants Main Office based in Northwest Houston. 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.
Responsibilities:
1. Manages Texas Non-Subscriber claims in accordance with the Pappas Injury Plan, Paptex.
2. Conducts investigations, determines eligibility, and explains benefits to team members.
3. Manages treatment plan including selecting specialists when needed.
4. Establishes reserves based on severity of known medical treatment and future treatment plan.
5. Processes medical bills through an audit process and codes / approves payment of bills. Enters data into claims system.
6. Responsible for writing Benefit Determination Letters, Non-Compliance Warning Letters and Denial of benefits letters in accordance with the Paptex plan.
7. Reports wage replacement eligibility to Pappas payroll department.
8. Additional projects and duties as assigned.
Requirements
• Licensed adjuster (All Lines or Property and Casualty)
• Minimum of 5 years of experience adjusting Workers Compensation or Texas Non-Subscriber claims
• Fluent in Spanish required
• Bachelor’s degree in any field of study required
• Strong communication skills – ability to articulate benefit decisions in a positive manner and adjust communication to the 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
• Ability to work well under pressure and prioritize multiple tasks
• 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
Additional Information
This job posting contains some general information about what it is like to work at Pappas Restaurants and is not a complete job description. Pappas Team Members perform a number of different tasks every day, and this posting does not list all of the essential functions of the job.
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.