Senior Claims Adjuster Jobs

Job Title

Senior Claims Adjuster

Agency

Texas A&M University System Offices

Department

Risk Management

Proposed Minimum Salary

Commensurate

Job Location

College Station, Texas

Job Type

Staff

Salary:

$4,180.17 – $7,763.16 per month commensurate with experience.

Summary:

This position investigates, coordinates, monitors and initiates compensation payments and processes assigned claims for The Texas A&M University System.

Responsibilities:

• Manages and evaluates medical providers' report of disability, make reasonable assessment of impairment rating, and communicate with employer, employee, provider, and attorney.
• Identifies billed treatment to determine compliance with Texas Department of Insurance, Division of Worker's Compensation medical guidelines and ground rules and determine causal relationship to given diagnosis and compensable injury.
• Establish third party liability and initiate notice of subrogation rights, monitor third party losses and assist in settlement process.
• Monitor claimant treatment. Initiate peer consultant review, dispute resolutions and independent medical exam procedures. Update computer software with information received.
• Conducts reviews and investigate claims for acceptance or denial.
• For worker's compensation, compute average weekly wages and indemnity payment rate, adjust claimant's loss time payment, initiate loss time payments, monitor compliance with statutory mandates and initiate adjustment periods.
• Monitor records, procedures and documents to ensure compliance. Communicate deviation with employer, employee, provider, Texas Department of Insurance, Division of Workers' Compensation and claimant representative.
• Coordinates and prepares file for Benefit Review Conferences (BRCs) and Contested Case hearings to include documentation that supports the A&M System's defense from internal and external sources. Present documentation at BRCs.

For property/casualty/auto claims adjusting:

• Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
• Investigate and assess damage to property.
• Other duties as assigned.
• Refer questionable claims to investigator or claims adjuster for investigation or settlement.
• Prepare report of findings of investigation.
• Examine claims form and other records to determine coverage.
• Analyze information gathered by investigation and report finding and recommendations.
• Examine titles to property to determine validity and act as company agent in transactions with property owners.
• Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
• Communicate with former associates to verify employment record and to obtain background information regarding persons or businesses apply for credit.
• Collect evidence to support contested claims in court.
• Interview or correspond with claimant and witnesses, consult police and hospital records, and inspect property damage to determine extent of liability.

Education and Experience:

• Bachelor’s degree in applicable field or equivalent combination of education and experience.

• Three years of related experience.

Registration, Certifications, and Licenses:

• Current Texas Department of Insurance license all lines, property/casualty or worker's compensation or ability to obtain job specific license within 6 months of employment.

Knowledge, Skills, and Abilities

• Excellent written and verbal communication skills.

• Working knowledge of legal, medical and business terms.

• Knowledge of Texas Department of Insurance, Division of Workers' Compensation Statutes, Rules, Regulations and Procedures.
• Ability to travel independently for conferences, continuing education and site inspections.

• Ability to independently manage time to meet objectives.

• Ability to multitask and work cooperatively with others.

Other Requirements:

This is a security-sensitive position and is restricted to U.S. citizens and legal permanent residents only. Only complete applications will be considered for employment at The Texas A&M System Offices. Incomplete job application data could result in your application being rejected without an option to reapply. A resume may be submitted in addition to a completed employment application.

All positions are security-sensitive. Applicants are subject to a criminal history investigation, and employment is contingent upon the institution’s verification of credentials and/or other information required by the institution’s procedures, including the completion of the criminal history check.

Equal Opportunity/Affirmative Action/Veterans/Disability Employer.