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Texas Department of Insurance

The Texas Department of Insurance (TDI) is a state agency responsible for both consumers and the insurance industry. We work to fulfill our legislative mandate to regulate the insurance industry, administer the Texas workers’ compensation system, and promote a healthy insurance marketplace, while also protecting the people and the businesses that are served by insurance. We take our responsibility to Texans seriously and strive for excellent customer service through our professional attitude, competence and efficiency.

Important notice: Read before you apply

Veterans’ preference:

To receive veterans’ preference, applicants must provide at least one of the following documents with their State of Texas Application:

  • a copy of the DD 214, member #4;
  • a statement of compensation from the Veterans Benefits Administration; or
  • a copy of the DD 1300.

Applicable Military Occupational Specialty (MOS) codes are included, but not limited to one of the following: Military Occupational Specialty codes are not available at this time.

Additional Military Crosswalk information can be accessed at:

http://www.hr.sao.texas.gov/Compensation/MilitaryCrosswalk/MOSC_Insurance.pdf

Veterans: Go to www.texasskillstowork.com for assistance with translating your military work experience and training courses into civilian job terms, qualifications/requirements and skill sets.

Current opportunity: Claims Examiner I

Internal/External Posting – TDI Employees and General Public

The Claims Examiner I performs routine (journey-level) workers’ compensation work. Work involves reviewing and evaluating claims for benefits and extensive data entry. Works under moderate supervision with limited latitude for the use of initiative and independent judgement.


This position:

  • reviews and evaluates requests for designated doctor examinations; makes determinations regarding the approval or denial of these designated doctor examination requests in accordance with applicable statutes, rules, policies, and procedures;
  • researches and reviews workers’ compensation claims and correspondence in various databases and the TXCOMP Claims and Coverage Systems;
  • analyzes reported injuries and medical conditions to determine qualified designated doctors to assign to claims and provides proper documentation regarding assignments;
  • coordinates the examination between the designated doctor and the injured employee;
  • prepares forms, letters, and supporting materials to complete the request for designated doctor examination process;
  • assists in identifying and reporting potential fraud or non-compliance activities of system participants; and
  • performs other duties as assigned.

Qualifications

Thirty college hours. Education and experience relevant to position requirements may be substituted for one another on a year-for-year basis.


Additionally, this position:

  • requires one year experience in clerical or administrative capacity; and
  • prefers one year experience using Microsoft Word and Excel software applications.

Preferences for this position include:

  • three years of experience in coordinating schedules;
  • providing customer service in an office environment; and
  • bilingual in English and Spanish language skills (oral and written).

This position requires demonstrated knowledge of:

  • relevant Texas Workers’ Compensation Acts and Rules;
  • data entry;
  • principles and practices of office administration; and
  • business terminology, spelling, grammar, and mathematics.

This position requires demonstrated skill in:

  • customer service;
  • decision making, planning, and problem solving;
  • use of correct grammar, punctuation and spelling;
  • use of personal computer software such as Microsoft Word and Excel software applications; and
  • use of automated equipment.

This position requires the demonstrated ability to:

  • handle multiple tasks simultaneously and manage conflicting priorities in order to meet deadlines;
  • perform extensive data entry for long periods of time;
  • effectively communicate both orally and in writing;
  • meet established deadlines;
  • understand and carry out complex instructions;
  • prepare and maintain complex records and files;
  • make decisions in accordance with rules, regulations, and procedures;
  • apply critical thinking to analyze and solve work problems;
  • establish and maintain effective working relationships with various individuals both internally and externally;
  • prioritize workload in order to meet statutory and established deadlines; and
  • lift and carry up to 50 lbs.

Position details

Opening date:06/28/2018
Functional title:Claims Examiner I
Classification title:Claims Examiner I
Status:Internal/External Posting – TDI Employees and General Public
Application deadline:Until Filled
Pay group:B14
Monthly salary: $2,595.33
Annual salary:$31,143.96
Job posting number:18-297
Division:Division of Workers’ Compensation/Designated Doctor Operations
Location:7551 Metro Center Drive, Ste. 100, Austin, TX 78744
Travel required:5 %

 

For more information, contact:

Last updated: 6/28/2018