SORM | Claims Adjuster - Senior Claims Adjuster |

GENERAL DESCRIPTION The State Office of Risk Management (SORM) is seeking an experienced Claims Adjuster with a specialization in Workers’ Compensation claims to serve in Austin, Texas. The ideal candidate will manage a caseload of workers’ compensation claims with a primary focus on lost time claims, applying knowledge of the Texas Workers’ Compensation Act, Division of Workers’ Compensation Rules, and Texas Administrative Code. ESSENTIAL POSITION FUNCTIONS Reviews, determines compensability, and evaluates 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 to establish compensability. Anticipates customer needs and facilitates appropriate solutions; develops and maintains effective working relationships with claimants, client agencies, and 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 the 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. ADDITIONAL RESPONSIBILITIES FOR HIGHER‑LEVEL ROLES For Claims Examiner III: Represents the State of Texas in administrative hearings involving workers’ compensation, as needed (additional to the functions above). For Claims Examiner IV: Serves as a subject matter expert on claims administration, as needed (additional to the functions above). QUALIFICATIONS Education: Graduation from high school or equivalent. Education: Bachelor’s degree from an accredited college or university with a major in business, insurance, or a closely 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 claims. Licensed to adjust workers’ compensation claims in Texas (license will be verified pre‑employment). Knowledge of medical terminology. Knowledge of the 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 law 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 business‑related travel. Ability to work more than 40 hours as needed and in compliance with the FLSA. Ability to lift and relocate 30 lbs. Ability to travel (including overnight travel) up to 5%. ADDITIONAL QUALIFICATIONS FOR HIGHER‑LEVEL ROLES For Claims Examiner III: Experience – one additional year of full‑time experience in reviewing, adjusting, or processing workers’ compensation claims. For Claims Examiner IV: Experience – one additional year of full‑time experience in reviewing, adjusting, or processing workers’ compensation claims. PREFERRED QUALIFICATIONS Education: Licensed LVN, RVN, or other professional certification in physical therapy or related medical field. Certifications: Associate in Claims or other related insurance certification. Advanced knowledge of medical and pharmaceutical terminology. Advanced knowledge of generally accepted medical procedures. BENEFITS As a state employee, you are automatically enrolled in the state’s retirement plan and are eligible for additional health insurance benefits. EEO STATEMENT THE SORM IS AN EQUAL OPPORTUNITY EMPLOYER. #J-18808-Ljbffr