- Analyze workers' compensation claims in compliance with NYS Workers' Compensation law and regulatory procedures and requirements.
- Assists in determining if claim is compensable under WCL and sets initial loss claim reserves.
- Determine if workers' compensation benefits are due and make timely and accurate payments and/or adjustments of benefits.
- Review more complex issues with contracted medical bill review consultants.
- Submit payments accurately and timely through county's risk management system.
- File all applicable state forms within statutory limits.
- Fully utilize various information technology applications including NYS WC electronic case files and medical bill review system.
- Code claim information accurately and completely detail claim history and activity.
- Prepare case files for hearings, appeals and trial ensuring all filings are in order.
- Confers with the County's outside legal counsel regarding complex case management issues to ensure proper resolution.
- Complies with Board directives and decisions and recommends appeals as needed.
- Communicate timely and professionally, both written and verbally, with departments, legal counsel, claimants and medical providers regarding claim developments and Workers' Compensation rules and regulations.
- This position does not offer relocation assistance at this time
- Good knowledge of Workers' Compensation laws, regulations and rates of payment
- Good knowledge of procedures for processing claims, payments and reimbursements and for controverting claims
- Some knowledge of the legal aspects of Workers' Compensation claims
- Ability to evaluate claims by applying appropriate laws, rules and regulations
- Ability to perceive illegitimate claims and/or disqualifying conditions needing further investigation or examination
- Ability to deal effectively with others
- Ability to maintain accurate records and files of claims and supporting documentation
- Ability to express oneself clearly and concisely both orally and in writing
- Good powers of observation and perception
- Tact and good judgment
- Physical condition commensurate with the demands of the position.
- Our focus is to promote, support, and implement the County-wide diversity and inclusion strategic plan.
- We achieve results in all our responsibilities through the use of diversity and inclusion best practices.
- We maintain a familiarity with Diversity & Inclusion trends and best practices.
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Workers' Compensation Claims Examiner - Hauppauge, United States - Suffolk County, NY
Description
An employee in this class performs difficult examining work in a Workers' Compensation claims unit.Responsibility is included for making an initial determination to accept or controvert a claim by applying guidelines established by New York State Workers' Compensation laws and procedures, and for explaining regulations and procedures to employees and department administrators.
Work requires considerable initiative and judgment and is performed under general technical or administrative supervision. Does related work as required.Key Elements Of The Role:
Salary:
$44,266
OPEN COMPETITIVE
Minimum Qualifications and Experience
Graduation from high school or possession of a high school equivalency diploma and three (3) years of experience in applying Workers' Compensation rules and regulations in the review and processing of claims.
NOTE:
Additional education from college with federally-authorized accreditation or registration by NY State may be substituted for up to two (2) years of the above experience.
Additional Skills For The Role:
A provisional appointment, which occurs only in the competitive class, is a temporary appointment to a position for which no eligible list exists or for which an eligible list exists with fewer than three candidates who are willing to accept the position.
In order to become permanent, the employee who is provisionally appointed must take the next examination for the position in question.
The appointment to the position is then made from among the three highest scoring passing candidates who indicate their willingness to accept the position.
Civil Service law does not compel the appointing authority to choose the provisional employee should he or she be one of the three candidatesAdditional details regarding a Provisional Appointment can be reviewed at:
Suffolk County's Commitment to Diversity, Inclusion & Equity:
Suffolk County is an Equal Employment Opportunity Employer and does not discriminate against applicants or employees on the basis of race, color, religion, creed, national origin, ancestry, disability that can be reasonably accommodated without undue hardship, sex, sexual orientation, gender identity, age, citizenship, marital or veteran status, or any other legally protected status.
