Conduit

SORM |Claims Adjuster| 26-0531

at Texas Department of Information Resources (DIR)


GENERAL DESCRIPTION

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 Management’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. 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

  • 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