Claims adjuster Jobs in Austin, TX

Claims Adjuster Or Insurance Adjuster

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.

SORMs 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. SORMs 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 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

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

Qualifications

Minimum Qualifications :

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 law 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%

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.