Claims Adjuster (Workers' Compensation)

Responsible for investigating and administering assigned Liability claims involving property damage only and minor injuries and/or Workers' Compensation claims involving medical only and minor lost time claims and when warranted pursue litigation and subrogation against third parties. Individual should have the appropriate Texas Adjuster licenses to adjust either line of claim, liability or workers' compensation.  Performs duties in a safe, efficient manner and in compliance with all applicable rules and safety procedures.

• Investigates and administers assigned Liability and/or Workers' Compensation claims, including litigation.
• Sets appropriate financial reserves either factor or case reserves and maintains adequate funding.
• Sets appropriate diary date schedule according to approved intervals of file reviews.
• Takes recorded statements from involved parties and explains the Texas Tort Claims Act Law and/or the Workers' Compensation benefits and procedures as needed.
• Requests indexing of all injured parties through ISO CMS.
• Requests damage appraisals, police reports, medical bills, medical reports and wage information.
• Reviews facts, establishes liability, evaluates damages and negotiates appropriate settlements within the authority granted, including claims committee monetary evaluations based upon all known facts.
• Reviews facts, pays benefits and medical expenses in accordance with Workers' Compensation Act. 
• Evaluates claims according to Workers' Compensation Labor code and administers day to day activities while claim is active. Obtains necessary information from employees' doctors to make eligibility determination.
• Investigates, evaluates and pays reasonable and necessary benefits on lost time claims with authority up to $5,000.
• Monitor Impairment Income benefits 15% or lower. 
• Maintains contact with all parties regarding claims (i.e., doctors, employees, and line supervisors).
• Coordinates investigation with adjusters to avoid duplication of processes and subrogation pursuit. 
• May represent METRO at all hearings as required by the Texas Department of Insurance/Division of Workers Compensation. Provides information required by TDI/DWC, attorneys, DWC hearing representatives and other involved parties.
• May represent METRO at mediations, depositions, pretrial hearings and other legal proceedings as deemed appropriate. Responds to interrogatories as required. Reviews and pays legal bills.
• Provides any additional information requested by supervisors or lawyers relating to claims. 
• Reviews claim files on a daily diary basis and pursues subrogation and salvage recoveries.
• Promotes safety awareness and follows safety procedures in an effort to reduce or eliminate accidents.
• Performs other duties as assigned.

High school diploma or GED.  Associates degree preferred.
 
Minimum three (3) years related work experience.
 
Must have functional knowledge of the Texas Tort Claims Act and/or Texas Workers' Compensation Act and the appropriate Texas Insurance Adjusters License in one of these types; Texas Property & Casualty, Texas Workers' Compensation or a Texas All Lines license.  Excellent analytical skills in researching and reviewing negligence, accident reports, statements or interrogatories, medical bills, indexes and medical narratives. Good communications (written/verbal) skills and the ability to negotiate cost effective settlements.  Must have an understanding of legal, insurance and medical terminology.

The Metropolitan Transit Authority of Harris County, Texas has a zero tolerance drug and alcohol policy for all employees. All internal and external applicants will be required to undergo drug testing before employment and will be subject to further drug and/or alcohol testing throughout their employment.

Further, employees who perform safety-sensitive functions will submit to drug and/or alcohol testing in accordance to the Department of Transportation (DOT) and the Federal Transit Administration (FTA) regulatory requirements.

We provide equal opportunity to all qualified individuals regardless of race, color, religion, age, sex, national origin, veteran status, genetic information or disability.

Grade 08