Senior Claims Adjuster (23-0660)

GENERAL DESCRIPTION

• The State Office of Risk Management (SORM) is currently seeking an experienced Claims Adjuster or Insurance Adjuster who specializes in adjusting Workers' Compensation claims.  The ideal candidate will have high-level knowledge and experience in investigating, analyzing, filing disputes, and paying benefits in accordance with the Texas Workers' Compensation Act and Rules, 28 Texas Administrative Code (TAC).  This individual will manage a caseload of workers' compensation claims on one of three teams in the office, with a focus on lost time claims.    
• Performs moderately to highly advanced workers' compensation claims administration. Work involves reviewing, approving, or rejecting claims as provided in the Texas Labor Code and Division of Workers' Compensation Rules. 
• SORM is a unique state agency. We serve the public by directly serving other state entities with their workers' compensation claims, insurance and risk management programs, and continuity of operations (COOP) plans. SORM's unique culture embraces communication, creativity, and critical thinking. We hire results-oriented, curious, innovative, and adaptable people with a strong desire to help our clients, and one another, succeed. SORM continually seeks to enhance the agency's expertise and service by hiring talented people whose aspirations align with the Office's vision. If you are a service-minded professional looking for the stability of state service, we would love to visit with you.
• As a state employee, you are automatically enrolled in the state's retirement plan and are eligible for additional health insurance benefits.

ESSENTIAL POSITION FUNCTIONS

• Claims Examiner II:
  • Reviews, determines compensability, and lost time workers' compensation claims in accordance with the Texas Workers' Compensation ACT, DWC rules and regulations and internal procedures
  • Updates the claim file daily; uses the Origami system to enter, retrieve, and update claims files
  • Interviews claimants, medical providers, witnesses, and other agency personnel in order to establish compensability
  • Anticipates customer needs and facilitates appropriate solutions; develops and maintains effective working relationships with claimants, client agencies, and other internal/external customers
  • Obtains recorded statements from claimants
  • Analyzes data and presents ideas effectively both orally and in writing
  • Prepares clear and concise written reports and correspondence to claimants, medical consultants, and agency personnel
  • Represents the State of Texas in administrative hearings involving workers' compensation, as needed
  • Performs related work as assigned
  • Maintains relevant knowledge necessary to perform essential job functions
  • Attends work regularly in compliance with agreed-upon work schedule
  • Ensures security and confidentiality of sensitive and/or protected information
  • Complies with all agency policies and procedures, including those pertaining to ethics and integrity
• Claims Examiner III- All of the above functions for Claims Examiner II, PLUS
  • Represents the State of Texas in administrative hearings involving workers' compensations, as needed
• Claims Examiner IV- All of the above functions for Claims Examiner III, PLUS
  • Serves as a subject matter expert on claims administration, as needed

MINIMUM QUALIFICATIONS

• Claims Examiner II:
  • Education: Graduation from high school or equivalent
  • Education: Bachelor's degree from an accredited college or university with major in business, insurance, or close related field; full-time experience in reviewing, adjusting, or processing workers' compensation claims may be substituted for the required education on a year-for-year basis:
  • Experience: Six months full-time reviewing, adjusting, or processing insurance and/or workers' compensation 
  • Licensed to adjuster workers' compensation claims in Texas {License will be verified pre-employment}
  • Knowledge of medical terminology
  • Knowledge of Division of Workers' Compensation appeals process
  • Knowledge of Texas Workers' Compensation law and claims administration
  • Skill in handling multiple tasks, prioritizing, and meeting deadlines
  • Skill in effective oral and written communication {Writing sample will be administered at time of interview}
  • Skill in exercising sound judgment and effective decision making
  • Ability to interpret and appropriately apply complex rulings regarding Texas Workers' Compensation lad and claims administration
  • Ability to receive and respond positively to constructive feedback
  • Ability to work cooperatively with others in a professional office environment
  • Ability to provide excellent customer service
  • Ability to type 30 wpm [Typing test required at time of interview}
  • Ability to arrange for personal transportation for business-related travel
  • Ability to work more than 40 hours as needed and in compliance with the FLSA
  • Ability to lift and relocate 30 lbs.
  • Ability to travel (including overnight travel) up to 5%    
• Claims Examiner III-All of the above qualifications for Claims Examiner II, PLUS
  • One additional year full-time experience in reviewing, adjusting, or processing workers' compensation claims
• Claims Examiner IV-All of the above qualifications for Claims Examiner III, PLUS
  • One additional year full-time experience in reviewing, adjusting, or processing workers' compensation claims

PREFERRED QUALIFICATIONS

• Education: Licensed LVN, RVN, or other professional certification in physical therapy or related medical field 
• Certifications: Associate in Claims or other related insurance certification
• Advanced knowledge of medical and pharmaceutical terminology
• Advanced knowledge of general accepted medical procedures

TO APPLY
All applications for employment with the State Office of Risk Management must be submitted electronically through www.WorkInTexas.com. A State of Texas application in WorkInTexas (WIT) must be completed to be considered OR Submit a State of Texas Application for Employment to: Attn: Linda Griffin, State Office of Risk Management, P.O. Box 13777, Austin, TX 78711-3777. Military Crosswalk information can be accessed at https://hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_Insurance.pdf
        
THE SORM IS AN EQUAL OPPORTUNITY EMPLOYER