Workers Compensation Claims Adjuster

ROLE AND PURPOSE: Under general supervision of the director, performs various professional duties in support of the AISD workers' compensation claims processing. This includes reviewing, examining, investigating, analyzing, and processing workers' compensation claims. Review claims documentation for compensability and subrogation issues; monitor TPA's charges on medical, indemnity benefits, and relevant payments; provide information and assistance to AISD staff, injured employees, claim administrators, and medical and legal professionals; and perform related duties as assigned. Work with all AISD departments and identify transitional duty candidates based on the information received on return-to-work status reports from the TPA and injured employees' treating physicians. Coordinates back-to-work transition, adhering to employee's restrictions, by providing a Bona Fide Job Offer to the injured employee to bring them back to work. Work with injured employees, all AISD departments, and HR partners and maintain open communication to achieve employee satisfaction and AISD's occupational health and safety goals. The employee in this position will spend 50% of work time on field operations, collaborating with various departments to identify the root causes of injuries and strategize on how to minimize them effectively.

QUALIFICATIONS:    

Education/Certification:

• A bachelor's degree with major in insurance, business, or related field
• Coursework emphasis in workers' compensation, risk management, environmental health, or equivalent preferred
• Texas Workers Comp Adjuster License preferred
• Bilingual, preferred

Experience:        

• Two years of recent progressively responsible experience adjusting workers' compensation claims.
• Experience in a self-insured, public-sector environment is highly desirable.

SPECIAL KNOWLEDGE/SKILLS:

• Microsoft Office, MS Excel, PeopleSoft, Canvas, Engage, and Blackboard.
• Office equipment (e.g., computer, copier)
• Must be detail-oriented and could handle multiple tasks and meet strict deadlines.
• Capacity to write reports and plan documents requiring technical precision, accuracy, readability, and editorial correctness.
• Working knowledge of computers and ability to work with and integrate new software.
• Ability to interpret laws and regulations and apply them to work situations.
• Ability to perform investigations, analyze findings, and determine causes.
• Excellent investigation skills and oral and written communication skills.
• Excellent human relations skills.
• Specialized certifications are desirable.

MAJOR RESPONSIBILITIES AND DUTIES:  

I. OPERATIONAL TASKS AND SUPPORT RESPONSIBILITIES:

• Serve as the subject matter expert for the claims and insurance programs to support Arlington ISD's needs under the general direction and guidance of HR leadership. Facilitate claims reporting and processing with TPA.
• Conduct research and analyze information. Identify issues and process claims in a timely fashion within the timeframes prescribed by law.
• Gather, organize, compile, and summarize data. Create and maintain various ledgers, logs, records, and reports.
• Process and investigate claims as assigned, identifying root causes and solutions to minimize injuries and incidents. Take recorded statements from involved parties as needed.
• Review facts and pay benefits and medical expenses in accordance with the Texas Workers' Compensation Act.
• Evaluate claims according to the Texas Workers' Compensation Labor Code and work with the TPA to process them. Obtain necessary information from employees' doctors to make eligibility determinations as needed.
• Maintain contact with all parties regarding claims (e.g., doctors, clinics, employees, foremen/supervisors, and TPAs).
• Promote safety awareness and collaborate with all AISD departments to reduce or eliminate injuries and accidents.
  • Investigate and evaluate all assigned claims in a timely manner, per departmental guidelines.
  • Conduct onsite injury/incident consultation, investigation, and training visits.
  • Participate/lead safety walkthrough/inspections.
• Handle and escalate issues passed on from TPAs, staff, and supervisors through proper channels.
• Successfully handle scheduling, organizing, record-keeping, monitoring progress, tracking paperwork, updating the "need-to-know group" and partners, and managing information flow.
• Responsible for implementing AISD's return-to-work program, supporting AISD employees as they recover at work, and assisting AISD in meeting the obligations required under workers' compensation legislation.
• Prepare a variety of meaningful and concise reports, documents, and memoranda.
• Develop top-quality analytics and presentations for senior management and other stakeholders.
• Prepare and maintain accurate financial records and documents.
• Coordinate investigation with adjusters and assist with subrogation interest.
• Assist departments on compliance issues and proper completion of applicable forms.
• Develop and present value-added information to department staff so they can make prudent decisions on how to minimize injuries and incidents.
• Maintain a working diary on all assigned claims, per departmental guidelines.
• Comply with all filing requirements as mandated by applicable governing laws.
• Operate office equipment, including computers and supporting word processing and spreadsheet applications. Adapt to changing technologies and learn the functionality of new equipment and systems.
• Maintain a comprehensive activity log documenting weekly duties performed.
• Independently assess coverage and compensability for all assigned claims with minimal supervision.
• Represent AISD in mediations, Benefit Review Conferences, and other workers' compensation proceedings as necessary.
• Review, analyze, and compile claims reports as requested by the director.
• Assist with GL claims as needed.
• Request and review damage appraisals, police reports, medical bills, medical reports, wage information, and monthly bills from TPAs.

II. PROFESSIONAL GROWTH AND DEVELOPMENT

• Assumes responsibility for own professional growth and development; for keeping current with the rules and regulations, literature, new research findings, and improved techniques in risk management.
• Assumes responsibility for identifying professional growth needs.
• Exhibits flexibility in the performance of assigned duties.
• Manages time wisely and effectively.
• Seeks feedback on job performance from all department staff and peers.

III. TRAVEL RESPONSIBILITIES

• None

IV. SUPERVISORY RESPONSIBILITIES:

• None

V. OTHER DUTIES:

• Fulfill additional responsibilities as delegated by the Department Director.
• Ensure the current adjuster license is maintained throughout employment.

VI. WORKING CONDITIONS:

MENTAL DEMANDS / PHYSICAL DEMANDS / ENVIRONMENTAL FACTORS

• Tools/Equipment Used: Standard office equipment including computer and peripherals; standard instructional equipment.
• Posture: Moderate standing; occasional kneeling, squatting, bending, and stooping
• Motion: Moderate walking
• Lifting: Regular light lifting and carrying (less than 15 pounds)
• Environment: Work inside and outside (exposure to sun, heat, cold, and inclement weather); exposure to noise
• Mental Demands: Work with frequent interruptions; maintain emotional control under stress, with frequent interruptions.