Job Title: Early Assistance Advocate for Injured Employees (Ombudsman I)
Job Responsibilities:
An Early Assistance Advocate (Ombudsman I) plays a critical role in assisting injured employees in understanding and navigating the Texas workers’ compensation claims process. The responsibilities of this position include:
- Assisting injured employees one-on-one and answering their questions.
- Reviewing claims for medical and income benefits and analyzing case backgrounds.
- Gathering and evaluating information, including medical records and letters from doctors.
- Preparing and responding to requests for Designated Doctor examinations.
- Evaluating and implementing strategies to resolve claims early.
- Reporting and referring complaints as needed.
- Educating injured employees about the workers’ compensation dispute process and relevant laws and rules.
- Advocating for the expedient resolution of claims by assembling necessary evidence for insurance carrier determinations or benefit proceedings.
- Contacting insurance carriers and medical providers to identify and resolve disputes.
- Assisting with referrals to social services and other state agencies.
- Providing assistance in filing claims and obtaining supporting documentation from doctors.
- Routinely contacting injured employees to update them on claim statuses and discuss upcoming events.
- Documenting customer contact in the computer system and answering general customer service questions.
- Performing other duties as assigned.
Education and Experience Information:
The position requires the following qualifications:
- Graduation from an accredited four-year college or university.
- One year of experience in claims management, insurance, casework, healthcare, social work, law office (paralegal/legal assistant), or workers’ compensation. Education and relevant experience may be substituted for one another on a year-for-year basis.
The position also requires knowledge of:
- Microsoft Word, Excel, and Outlook.
Demonstrated skills required include:
- Assisting the public and conflict resolution.
- Handling and solving problems.
- Report writing and record maintenance principles and practices.
- Interpreting and explaining laws and regulations.
- Data entry and retrieval.
- Customer service.
- Use of correct grammar, punctuation, and spelling.
The ability to manage multiple, competing priorities, establish and maintain effective working relationships with a variety of individuals and groups, and communicate effectively both verbally and in writing with all levels of employees and the public are also essential.
Salary Information:
The salary for the Early Assistance Advocate (Ombudsman I) is set at $3, per month. The position is classified under the State Job Code: 3660, Salary Admin Plan: B, Grade: 17, and is exempt from overtime.
Additional Information:
The position is full-time, with a standard workweek of 40 hours, and requires 25% travel. The role is under moderate supervision, with limited latitude for the use of initiative and independent judgment.
Applicants should note that regular attendance is an essential function of every job at the **Members Only** (OIEC). Criminal background checks will be conducted on all final candidates, and those with a criminal offense relevant to the position may be disqualified from employment.
Employment preferences are provided for former foster youth and military personnel, subject to the submission of appropriate documentation. The position is open to both internal and external candidates, and the application process involves completing supplemental questions through the Work in Texas platform.
The OIEC is an equal opportunity employer and does not discriminate based on race, color, national origin, gender, religion, age, or disability. Requests for reasonable accommodation during the application process can be directed to the appropriate email provided in the full job description.
