SORM | Claims Examiner II - IV | 27-0085

Please paste the following URL into a browser to view the entire job posting on the CAPPS Careers page.https://erphcmprd.cpa.texas.gov/psp/candidateportal/EMPLOYEE/HRMS/c/HRS\_HRAM\_FL.HRS\_CG\_SEARCH\_FL.GBL?Page=HRS\_APP\_JBPST\_FLandAction=UandFOCUS=ApplicantandSiteId=1andJobOpeningId=107111andPostingSeq=1Job DescriptionGENERAL DESCRIPTIONThe 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.As a state employee, you are automatically enrolled in the state's retirement plan and are eligible for additional health insurance benefits.ESSENTIAL POSITION FUNCTIONSReviews, determines compensability, and lost time workers compensation claims in accordance with the Texas Workers' Compensation ACT, DWC rules and regulations and internal proceduresUpdates the claim file daily; uses the Origami system to enter, retrieve, and update claims filesInterviews claimants, medical providers, witnesses, and other agency personnel in order to establish compensabilityAnticipates customer needs and facilitates appropriate solutions; develops and maintains effective working relationships with claimants, client agencies, and other internal/external customersObtains recorded statements from claimantsAnalyzes data and presents ideas effectively both orally and in writingPrepares clear and concise written reports and correspondence to claimants, medical consultants, and agency personnelRepresents the State of Texas in administrative hearings involving workers' compensation, as neededPerforms related work as assignedMaintains relevant knowledge necessary to perform essential job functionsAttends work regularly in compliance with agreed-upon work scheduleEnsures security and confidentiality of sensitive and/or protected informationComplies 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, PLUSRepresents the State of Texas in administrative hearings involving workers compensations, as needed Claims Examiner IV- All of the above functions for Claims Examiner III, PLUSServes as a subject matter expert on claims administration, as needed MINIMUM QUALIFICATIONSClaims Examiner II:Education: Graduation from high school or equivalentEducation: 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 terminologyKnowledge of Division of Workers Compensation appeals processKnowledge of Texas Workers Compensation law and claims administrationSkill in handling multiple tasks, prioritizing, and meeting deadlinesSkill in effective oral and written communication {Writing sample will be administered at time of interview}Skill in exercising sound judgment and effective decision makingAbility to interpret and appropriately apply complex rulings regarding Texas Workers Compensation lad and claims administrationAbility to receive and respond positively to constructive feedbackAbility to work cooperatively with others in a professional office environmentAbility to provide excellent customer serviceAbility to type 30 wpm [Typing test required at time of interview}Ability to arrange for personal transportation for business-related travelAbility to work more than 40 hours as needed and in compliance with the FLSAAbility 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, PLUSOne additional year full-time experience in reviewing, adjusting, or processing workers compensation claims Claims Examiner IV-All of the above qualifications for Claims Examiner III, PLUSOne additional year full-time experience in reviewing, adjusting, or processing workers compensation claims PREFERRED QUALIFICATIONSEducation: Licensed LVN, RVN, or other professional certification in physical therapy or related medical field Certifications: Associate in Claims or other related insurance certificationAdvanced knowledge of medical and pharmaceutical terminologyAdvanced 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.pdfTHE SORM IS AN EQUAL OPPORTUNITY EMPLOYER