Claims Supervisor
The University of Texas System · Austin, TX · 2 wk ago
FinanceFull-time
About the role
This position is responsible for supervising the claims handling function of the Workers' Compensation Insurance (WCI) program.
Responsibilities
- Oversee claims processing including daily handling of workers' compensation claims ensuring that (TPA) adjusters are in compliance with workers’ compensation laws and reporting requirements.
- Provide guidance to (TPA) adjusters on complex claims.
- Review and approve claim determinations prior to third party administrator (TPA) adjuster submitting to Division of Workers' Compensation (DWC).
- Work with the Office of the Attorney General to prepare files for contested case hearing (CCH) and district court.
- Attend CCH and district court proceedings with the Assistant Attorney Generals.
- Review and audit claim files for timeliness of indemnity payments, appropriateness of medical care, and general compliance.
- Liaison with institutions for claims-related information.
- Approve all TPA requests for peer reviews, required medical exams, private investigation, case management services, and other claims related services.
- Provide training and resource guidance to UT institutions.
- Communicate with TPA routinely to discuss processes and procedures for claims handling and payment services.
- Participate in special projects at the request of the Associate Director of WCI.
Qualifications
- Bachelor's degree in business or related field and 5 years of workers' compensation experience; relevant experience may be substituted for one year of college (30 semester hours) on a year-for-year basis.
- Texas all-lines adjuster license or obtain within 6 months from beginning date of employment.
Skills & Abilities
- Advanced knowledge of Texas Workers' Compensation Insurance statutes, rules and case law.
- Advanced knowledge of the Texas Department of Insurance Health and Workers' Compensation Network statute and rules.
- Advanced negotiation and problem-solving skills.
- Ability to maintain a collaborative team environment.
- Advanced verbal and written communication skills.