SORM | Claims Adjuster

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.

• 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

• 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 lad 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…