SORM | Claims Adjuster - Senior Claims Adjuster | 26-...

Please paste the following URL into a browser to view the entire job posting in the CAPPS Career Section: may apply to the job directly through the CAPPS Career Section. It is not necessary to apply both through Work In Texas and CAPPS Career SectionGENERAL DESCRIPTIONThe State Office of Risk Management (SORM) is currently seeking an experienced Claims Adjuster or Insurance Adjuster who specializes in adjusting Workersand#8217; 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 Workersand#8217; Compensation Act and Rules, 28 Texas Administrative Code (TAC). This individual will manage a caseload of workersand#8217; compensation claims on one of three teams in the office, with a focus on lost time claims. Performs moderately to highly advanced workersand#8217; compensation claims administration. Work involves reviewing, approving, or rejecting claims as provided in the Texas Labor Code and Division of Workersand#8217; Compensation Rules.SORMand#8217;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. SORMand#8217;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 youand#8217;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 stateand#8217;s retirement plan and are eligible for additional health insurance benefits.ESSENTIAL POSITION FUNCTIONSReviews, determines compensability, and lost time workersand#8217; compensation claims in accordance with the Texas Workersand#8217; 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 workersand#8217; 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 integrityClaims Examiner III- All of the above functions for Claims Examiner II, PLUSRepresents the State of Texas in administrative hearings involving workersand#8217; compensations, as neededClaims Examiner IV- All of the above functions for Claims Examiner III, PLUSServes as a subject matter expert on claims administration, as neededQualifications: 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 workersand#8217; compensation claims may be substituted for the required education on a year-for-year basisExperience: Six months full-time reviewing, adjusting, or processi g insurance and/or workersand#8217; compensationLicensed to adjuster workersand#8217; compensation claims in Texas {License will be verified pre-employment}Knowledge of medical terminologyKnowledge of Division of Workersand#8217; Compensation appeals processKnowledge of Texas Workersand#8217; 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 Workersand#8217; 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 workersand#8217; compensation claimsClaims Examiner IV-All of the above qualifications for Claims Examiner III, PLUSOne additional year full-time experience in reviewing, adjusting, or processing workersand#8217; compensation claimsPREFERRED QUALIFICATIONSEducation: Licensed LVN, RVN, or other professional certification in physical therapy or related medical fieldCertifications: Associate in Claims or other related insurance certificationAdvanced knowledge of medical and pharmaceutical terminologyAdvanced knowledge of general accepted medical proceduresTO 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. Military Crosswalk information can be accessed at SORM IS AN EQUAL OPPORTUNITY EMPLOYER

Created: 2025-11-01