Job Description

Claims Adjuster

The State Office of Risk Management (SORM) is currently seeking a Claims Adjuster who will review and determine compensability on workers compensation claims. This entry-level position will manage the intake of claim files interviewing claimants, medical providers, and others to determine the compensability of a claim; with opportunities for career advancement/growth. This person will review, approve or reject claims in accordance with the Texas Workers Compensation Act and division of Workers Compensation (DWC) Rules and will work under moderate supervision, with limited latitude for the use of independent judgment.

The State Office of Risk Managements 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. If youre 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 states retirement plan and are eligible for additional health insurance benefits.

Essential Position Functions

• Responds to calls and queries from internal and external customers
• Reviews, determines, compensability, and adjusts lost time workers compensation in accordance with Texas Workers Compensation Act, DWC rules and regulations and internal procedures
• Updates the claim file diary; uses the mainframe system to enter, retrieve and update claim files
• Interviews claimants, medical providers, witnesses, and other agency personnel in order to establish compensability
• Obtains recorded statements from claimants
• Analyzes data and present ideas effectively both orally and in writing
• Prepares clear and concise written reports and correspondence to claims, medical consultants and agency personnel
• 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

Qualifications

Minimum Qualifications:

• Education: Graduation from high school or equivalent
• Experience: One year of full-time experience working in the following (or closely related) fields: general office, complex clerical, and secretarial experience. Experience and education may be a substitute for one another
• Knowledge of medical terminology
• Knowledge of Texas Workers Compensation law and claims
• Skill in handling multiple tasks, prioritizing, and meeting deadlines
• Skill in effective oral and written communication {writing sample will be administered at the time of interview}
• Skill in exercising sound judgment and effective decision making
• Ability to receive and respond positively to constructive feedback
• Ability to work cooperatively with others in a professional office environment
• Ability to obtain and maintain an adjusters license
• Ability to provide excellent customer service
• 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%

Preferred Qualifications:

• Education: Bachelors degree from an accredited college or university
• Advanced knowledge of medical and pharmaceutical terminology
• Advanced knowledge of generally accepted medical procedures
• Associate in Claims or other related insurance certification

To Apply:

All applications for employment with the State Office of Risk Management must be submitted electronically through 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.

The SORM is an equal opportunity employer.

Job Tags

Similar Jobs