Claims Services Representative 1/Trainee 1/Trainee 2

6 months ago

Broome, Australia New York State Full time

Minimum Qualifications For Appointment to Claims Services Representative Trainee 1:
•Reachable on current Civil Service eligible list for this title; OR
•One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Investigator 1, Assistant Insurance Fund Services Representative, Program Aide; OR
•A bachelor's or higher degree (in any area of study).

For Appointment to Claims Services Representative 1, SG-18:
•Reachable on current Civil Service eligible list for this title; OR
•One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Administrative Specialist 1, Investigator 2 (Compensation Claims), Policyholder Services Representative 1, Underwriter 1, Underwriter 1 (Disability Benefits); OR
•A bachelor’s or higher degree AND two years of professional experience; OR
•A juris doctor, master’s or higher degree in a field related to the position being filled AND one year of professional experience.

Candidates who are active on the most recent Professional Career Opportunities examination list are encouraged to apply.

Please be advised that the New York State Insurance Fund does not offer sponsorship for employment visas to employees or potential employees. Candidates sponsored for employment by an organization should be aware of their sponsorship status and the relevant expiration date(s) of that sponsorship before applying to this position.

Duties Description Under the general supervision of a Claims Services Representative 2, oversees all aspects of workers compensation claims processing from inception to closing; initially determines the compensability of claims and files appropriate documentation with the Workers Compensation Board (WCB); calculates and adjusts reserves consistent with case analysis over the anticipated life of the claim; recommends cases for appeal to WCB; negotiates and/or makes recommendations regarding lump sum settlements; issues payments and requests for reimbursement where claims for supplemental benefits are involved; reviews awards to ensure the correct recipient and rate of compensation; schedules or waives medical examinations as necessary; analyzes medical bills to determine causality, levels of treatment, necessity for treatment, appropriateness of fees and procedure codes, and apportionment status; responds to requests for home modifications, home health care personnel, medication, and medical supplies and appliances; and reviews case activity and determines when a claim can be retired.

Specific duties to be discussed at time of interview.

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