Texas
Overview
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’s core missions are customer service oriented. We administer the workers' compensation program, insurance and risk management programs, and continuity of operations program for other state entities. SORM’s unique culture embraces communication, creativity, and critical thinking. We are seeking results-oriented, curious, innovative, and adaptable staff with a strong desire to help our clients, and one another succeed. If you’re looking for a fulfilling career in public 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
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
Experience: One additional year of full-time experience in reviewing, adjusting, or processing workers’ compensation claims
Claims Examiner IV-All of the above qualifications for Claims Examiner III, PLUS
Experience: One additional year of 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: Elaina Middleton, 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
#J-18808-Ljbffr
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’s core missions are customer service oriented. We administer the workers' compensation program, insurance and risk management programs, and continuity of operations program for other state entities. SORM’s unique culture embraces communication, creativity, and critical thinking. We are seeking results-oriented, curious, innovative, and adaptable staff with a strong desire to help our clients, and one another succeed. If you’re looking for a fulfilling career in public 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
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
Experience: One additional year of full-time experience in reviewing, adjusting, or processing workers’ compensation claims
Claims Examiner IV-All of the above qualifications for Claims Examiner III, PLUS
Experience: One additional year of 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: Elaina Middleton, 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
#J-18808-Ljbffr