Claims Adjuster (Special Investigations Unit)

Houston METRO (Metropolitan Transit Authority of Harris County) • Houston, TX

1d • $70,700 - $92,800

About The Position

Responsible for investigating claims with suspected fraudulent elements and administering assigned claims involving property damage, third party injury claims, and worker’s compensation claims. Performs duties in a safe, efficient manner and in compliance with applicable rules and safety procedures.

Requirements

• High school diploma or GED is required.
• Minimum five (5) years’ experience in liability and Workers’ Compensation claims investigations and administration.
• Must have functional knowledge of the Texas Tort Claims Act.
• Must possess a Texas All Lines adjusters’ license.
• Excellent analytical skills in researching and reviewing negligence laws, traffic code, accident reports, statements or interrogatories, medical bills, indexes, and medical narratives.
• Ability to evaluate evidence to substantiate or refute fraud allegations.
• Good communications (written/verbal) skills and the ability to negotiate cost effective settlements.
• Must have basic understanding of insurance and medical terminology.
• Must have basic understanding of compliance with state/federal laws and fair claim handling.

Nice To Haves

• Associate’s degree in Risk Management or Criminal Justice is preferred.

Responsibilities

• Investigates and administers assigned Liability and Worker’s Compensation claims with potentially fraudulent elements such as staged accidents, unsubstantiated claims, suspicious property damages, exaggerated injuries, and manufactured records or invoices.
• Analyze, investigate, establish liability, evaluate damages, and resolve potential fraudulent claims across various lines of coverage.
• Take recorded statements from parties involved and explain the Texas Tort Claims Act Law as needed.
• Conducts thorough research on individuals using public records, social media, surveillance, canvassing, law enforcement records, court records, and internal databases.
• Coordinates with local law enforcement, insurance companies, and legal counsel for potential litigation or filing of criminal charges.
• Sets appropriate diary date schedule according to approved intervals of file reviews.
• Requests indexing of all injured parties through Insurance Service Office and Centers for Medicare and Medicaid Services.
• Requests damage appraisals, police reports, medical bills, medical reports, and wage information.
• Sets appropriate financial reserves, either factor or case reserves, and maintains adequate funding.
• Acts as the Claims Department liaison with the District Attorney’s Office on criminal mischief cases.
• Maintain contact with all parties regarding claims (i.e., claimants, appraisers, medical providers, and vendors).
• Provides any additional information requested by supervisor relating to claims.
• Pursues subrogation when applicable.
• Provides excellent customer service to METRO internal and external customers.
• Applies Safety Management System (SMS) methods and principles in daily routine and supports all aspects of the agency’s Public Transportation Agency Safety Plan (PTASP).
• Promotes safety awareness and follows safety procedures to reduce or eliminate accidents.
• Performs other job-related duties as assigned.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED