SORM | Claims Adjuster - Senior Claims Adjuster | 26-0522

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