Claims Supervisor

Exempt


Earliest Start Date


Immediately

Salary


Salary commensurate with experience

Hours per Week


40.00 Standard from 8:00 AM to 5:00 PM


Hiring Department


Office of Risk Management

Required Application Materials


A resume and letter of interest is required to apply. Candidates under final consideration will also be required to submit professional references, college degree information, and employment history to an online third-party vendor.

About Us


For more than 140 years, The University of Texas System has improved the lives of Texans - and people all over the world - through education, health care, and research. The System consists of nine academic institutions, four health institutions, and The University of Texas System Administration. The institutions of the UT System employ more than 160,000 faculty, health care professionals, researchers, support staff, and student workers.


The UT System Administration is primarily based in Austin, Texas. It supports the missions of the System's thirteen institutions by providing financial, legal, planning, purchasing, government relations, communications, development, and other central services. Serving a growing state, the UT System Administration strives to provide a welcoming, supportive work environment that embraces different perspectives - not only because it enables the organization to be stronger, creative, and thoughtful, but because it is the right thing to do. To that end, UT System Administration embraces state laws on military and former foster children employment preferences.

Purpose of Position
This position is responsible for supervising the claims handling function of the Workers' Compensation Insurance (WCI) program by closely working with and reviewing the activity of the Third Party Administrator (TPA) adjusters, communicating regularly with the bill review and pre- authorization company and certified workers' compensation healthcare network.


Essential Functions

• Oversee claims processing including daily handling of workers' compensation claims ensuring that (TPA) adjusters are in compliance with workers' compensation laws and reporting requirements.
• Provide guidance to (TPA) adjusters on complex claims.
• Review and approve claim determinations prior to third party administrator (TPA) adjuster submitting to Division of Workers' Compensation (DWC).
• Work with the Office of the Attorney General to prepare files for contested case hearing (CCH) and district court.
• Attend CCH and district court proceedings with the Assistant Attorney Generals.
• Review and audit claim files for timeliness of indemnity payments, appropriateness of medical care, and general compliance.
• Liaison with institutions for claims-related information.
• Approve all TPA requests for peer reviews, required medical exams, private investigation, case management services, and other claims related services.
• Provide training and resource guidance to UT institutions.
• Communicate with TPA routinely to discuss processes and procedures for claims handling and payment services.
• Participate in special projects at the request of the Associate Director of WCI.
• Other duties as assigned.

Knowledge, Skills & Abilities

• Advanced knowledge of Texas Workers' Compensation Insurance statutes, rules and case law.
• Advanced knowledge of the Texas Department of Insurance Health and Workers' Compensation Network statute and rules.
• Advanced negotiation and problem-solving skills.
• Ability to maintain a collaborative team environment.
• Advanced verbal and written communication skills.

Required Qualifications

• Bachelors degree in business or related field and 5 years of workers' compensation experience; relevant experience may be substituted for one year of college (30 semester hours) on a year-for-year basis.
• Texas all-lines adjuster license or obtain within 6 months from beginning date of employment.

Preferred Qualifications

• Prefer 5 years of workers' compensation claims adjusting experience.
• Experience representing cases before the Texas Department of Insurance.

Working Conditions

• Repetitive use of a keyboard at a workstation
• Uses standard office equipment
• 25% Travel
• Requires occasional evening or weekend hours

Additional Information


The retirement plan for this position is Teacher Retirement System of Texas (TRS), subject to a minimum of 20 hours per week and at least 135 days in length. Participation in TRS is mandatory.

A background check will be conducted on candidates under final consideration. The background check may include any or all of the following: criminal history check, prior employment verification, education verification, professional references check, and motor vehicle records check. Background checks are conducted by third-party vendors. Upon request form the third-party vendor, candidates under final consideration must provide the required information for the background checks to be completed.

EO/AA Statement


The University of Texas System Administration is committed to providing equal employment opportunity for all qualified applicants and employees in all terms and conditions of employment. U. T. System will provide equal employment opportunity to all qualified persons and will not discriminate on the basis of race, color, sex, sexual orientation, gender identity/expression, pregnancy, religion, national origin, age, disability, genetic information, protected veteran status, or any other characteristic protected by federal or state laws.

For information on accommodations for individuals with disabilities, please contact the Office of Talent and Innovation at View email address on click.appcast.io .