Claims Examiner III

Overview Date: Jun 22, 2026. Location: BRYAN, TX. Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage. Functional Title: Claims Examiner III Job Title: Claims Examiner III Agency: Health & Human Services Comm Department: MEPD Disability Det EOAPD Posting Number: 18206 Closing Date: 07/06/2026 Posting Audience: Internal and External Occupational Category: Community and Social Services Salary Range: $3,793.41 - $5,921.25 Pay Frequency: Monthly Salary Group: TEXAS-B-18 Shift: Day Telework: Eligible for Telework Travel: Up to 40% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Nonexempt Job Location City: BRYAN Job Location Address: 3000 E VILLA MARIA Other Locations: Brenham; Austin; Killeen; Round Rock; Waco MOS Codes: No military equivalent Brief Job Description Are you a highly motivated, compassionate and dedicated individual looking for a rewarding career assisting the most vulnerable citizens of Texas in need of food, medical care, cash assistance and other social services? If so, the Texas Health and Human Services Commission (HHSC) Access and Eligibility Services (AES) division is looking for individuals who want to join an exciting, dynamic team working in a high-performing and innovative environment. AES provides an integrated and streamlined approach to connect individuals to services and supports that reduce institutionalization, allow individuals to remain in their communities, and promote economic and personal self-sufficiency. AES is built upon its core values of respect, ownership, collaboration, and integrity with a goal of delivering best-in-class customer service to clients and stakeholders. Our staff are well organized, able to multi-task, possess the ability to learn policy regulations, able to thrive in a challenging, fast-paced, and evolving environment, have good communication skills, a positive attitude, strong work-ethic and a desire to help others. We want you to join our team! Responsibilities This position is responsible for implementation of the disability determination policies/procedures. It reviews medical and social history information to determine applicant’s ability to perform substantial gainful activity under the Disability Determination application and review process for cases. It consults with staff physician, regional staff, medical providers, and legislators. It interprets program policies and procedures, prepares appeal summaries and participates in Fair Hearings for appeal cases. It works closely with the Disability Determination Manager to develop and maintain uniformity of disability determination processes and decisions. It assists the Manager in conducting presentations and training of disability determination policy and procedures to agency staff and others as requested. It assists the Manager in coordination of disability determination policy/procedure changes with appropriate policy staff. It provides technical supervision to clerical support staff. This position may require up to 40% of travel. Essential Job Functions (EJFs) Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. Provides interpretation and application of federal disability requirements and procedures in the disability determination process for Medicaid applicants. Receives social and medical records from the Medicaid Eligibility Specialist and may have direct contact with Medicaid applicants occasionally. The position interprets the medical and social records and applies the "Federal SSI Listings of Impairments" using the five step "Sequential Evaluation Process" to determine if the applicants meet federal requirements for disability eligibility. Errors of interpretations could result in loss of benefits or harm to the applicant’s health. Errors also could possibly result in federal sanctions and loss of Medicaid funds. Assists in the development of policies, procedures, rules, regulations or standards on disability determination cases. Provides complex technical assistance to regional staff, medical providers, legislators, and general public on policies, procedures, rules, regulations, standards or requirements in disability cases for Medicaid eligible applicants. Assists in the development and presentation of training on disability determination policy and procedures. Testifies as a technical authority and represents Disability Determination by participation in Appeal Hearings. May conduct program analyses and research to assess and formulate changes in processes or procedures. Knowledge, Skills and Abilities (KSAs) Knowledge: Health and Human Services Programs services and procedures; Medical reporting format and terminology. Skill: Analysis; Working independently Ability: Exercise tact, diplomacy and confidentiality in communication with others; Read and interpret medical reports in terms of residual functional capacity; Function as a member of a medical review team; Learn and apply state/federal disability policies and procedures; Pinpoint obscure detail; Work under pressure while maintaining effective and accurate performance; Communicate effectively both orally and in writing. Qualifications Initial Screening Criteria High School diploma or GED equivalent is required. Sixty (60) semester hours from an accredited college or university is required. Two (2) years of customer service experience may be substituted for required education. Experience working in a professional customer service environment. Two (2) years’ experience as an Eligibility Advisor – MES (Medicaid Eligibility Specialist). Experience within the last two (2) years in Medicaid or Medicaid for the Elderly and People with Disabilities (MEPD) policy and procedures. One (1) year experience as an Eligibility Advisor III – MES or higher, preferred. Texas Integrated Eligibility Redesign System (TIERS) and Eligibility Workload Management System (EWMS) experience is preferred. Experience in medical reporting and terminology preferred. Experience analyzing complex state and federal law and regulations preferred. Experience analyzing operations and problems and preparing reports of findings and recommendations preferred. Experience using Microsoft Word, Excel, and Outlook. Willingness to work beyond normal hours (8:00 AM – 5:00 PM). Willingness to travel. Additional Information This position can be housed anywhere in Region 07. Normal office hours are Monday-Friday 8:00am to 5:00pm; overtime may be required outside normal hours, including weekends. Applicants selected for hire will be required to pass a fingerprint background check. Applicants may not have a history of substantiated fraudulent activity against HHSC or any program it administers. Applicants with a non-fraud overpayment with an outstanding balance must agree to repay as a condition of employment. Active Duty, Military, Reservists, Guardsmen, And Veterans: Military occupations related to the role are listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified. ADA Accommodations: HHSC and DSHS agencies will provide reasonable accommodation during the hiring process for qualified individuals with a disability. For assistance, contact the HHS Employee Service Center. Telework Disclaimer: This position may be eligible for telework. All HHS positions are subject to state and agency telework policies and the discretion of the direct supervisor and business needs. Nearest Major Market: College Station #J-18808-Ljbffr