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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: Subsequent Injury Fund Claims Examiner

Internal/External TDI Employees and General Public

The Subsequent Injury Fund (SIF) Claims Examiner performs complex case specific reviews of requests for reimbursement from the SIF. Work involves performing and documenting detailed evaluations of requests for reimbursement of overpayment of benefits made by an insurance carrier.


This position:

  • reviews, researches, and evaluates all claim information including designated doctor reports, decisions and orders, and all benefits information to determine appropriate amount of reimbursement;
  • applies appropriate rules to calculate average weekly wage for the claim;
  • determines the appropriate amount of reimbursable medical benefits or indemnity benefits for the claim;
  • prepares letters, warrants, and supporting documentation related to the requests for reimbursement;
  • maintains a database to record and track requests for reimbursement and status of payout orders; and
  • identifies and reports cases involving potential fraud.

Qualifications

Graduation from an accredited four-year college or university.  Education and experience may be substituted for one another on a year-for-year basis.


Additionally, this position requires:

  • three and one half years’ experience in the area of accounting, insurance, auditing, claims, regulatory, or workers’ compensation.

Preferences for this position include:

  • experience in claims examination, disability determination, or payment of workers’ compensation insurance claims.

This position requires demonstrated knowledge of:

  • laws and regulations pertaining to workers compensation;
  • the Subsequent Injury Fund reimbursement process;
  • workers’ compensation dispute resolution process;
  • financial analysis, and claims examination;
  • medical and benefit terminology; and
  • spelling, punctuation, grammar, typing formats, and word processing techniques and procedures.

This position requires demonstrated skill in:

  • problem solving, decision making and planning;
  • the use of standard office equipment such as a 10-key;
  • using Microsoft Office software applications, including Word, Excel and Outlook;
  • using personal computers sufficient to enter and extract data from related systems and programs; and
  • plain English writing.

This position requires demonstrated ability to:

  • apply critical thinking to interpret and apply the laws and rules related to requests for reimbursement;
  • perform very detailed and technical calculations regarding insurance carrier payments and the carriers obligation to pay benefits;
  • manage and coordinate multiple tasks and priorities in order to meet necessary deadlines;
  • maintain confidentiality;
  • write professional business correspondence;
  • effectively communicate highly technical information, both verbally and in writing, with all levels of employees and the general public; and
  • establish and maintain an effective working relationship with managerial personnel, co-workers, and all levels of management.

Position details

Opening date:05/01/2018
Functional title:Subsequent Injury Fund Claims Examiner
Classification title:Claims Examiner III
Status:Internal/External TDI Employees and General Public
Application deadline:Until Filled
Pay group:B18
Monthly salary: $3,595.00
Annual salary:$43,140.00
Job posting number:18-228
Division:Division of Workers’ Compensation/General Counsel/Subsequent Injury Fund
Location:7551 Metro Center Dr., Suite 100, Austin, TX 78744
Travel required:5 %

 

For more information, contact:

Last updated: 5/1/2018