Fraud Investigations Claims Specialist (SIU)

Metropolitan Transit Authority of Harris County; Houston (TX); On-site; USD 71,000 - 93,000; Full time

Job summary

Metropolitan Transit Authority of Harris County in Houston, TX is seeking an experienced Claims Adjuster for the Special Investigations Unit to investigate potentially fraudulent liability and workers’ compensation claims. The role requires five years of relevant experience and a Texas All Lines adjusters’ license.

You will coordinate with law enforcement, insurers, and counsel, manage diary schedules, and pursue subrogation when applicable while maintaining excellent customer service to

Qualifications

• Analytical skills in researching and reviewing negligence laws, traffic code, accident reports, statements or interrogatories, medical bills, indexes, and medical narratives.
• Must possess a Texas All Lines adjusters’ license.
• Minimum five (5) years’ experience in liability and Workers’ Compensation claims investigations and administration.
• High school diploma or GED required; associate degree preferred.

Responsibilities

• Investigates and administers assigned Liability and Worker’s Compensation claims with potentially fraudulent elements.
• Analyze, investigate, establish liability, evaluate damages, and resolve potential fraudulent claims.
• 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, and court records.
• 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.
• Maintains contact with all parties regarding claims.
• Pursues subrogation when applicable.
• Provides excellent customer service to METRO internal and external customers.
• Applies Safety Management System (SMS) methods and PTASP procedures.
• Promotes safety awareness and follows safety procedures to reduce or eliminate accidents.
• Performs other job-related duties as assigned.

Skills

Analytical skills

Written communication

Verbal communication

Negotiation

Claims investigation

Insurance terminology

Education

High school diploma or GED

Associate’s degree in Risk Management or Criminal Justice

Job description

Metropolitan Transit Authority of Harris County in Houston, TX is seeking an experienced Claims Adjuster for the Special Investigations Unit to investigate potentially fraudulent liability and workers’ compensation claims. The role requires five years of relevant experience and a Texas All Lines adjusters’ license.

You will coordinate with law enforcement, insurers, and counsel, manage diary schedules, and pursue subrogation when applicable while maintaining excellent customer service to