Job Description
Duties Description Under the general supervision of a Claims Services Representative 2 responsibilities include, but are not limited to: Oversee all aspects of workers compensation claims processing from inception to closing Initially determine the compensability of claims and file appropriate documentation with the Workers Compensation Board (WCB) Calculate and adjust reserves consistent with case analysis over the anticipated life of the claim Recommend cases for appeal to WCB Negotiate and/or make recommendations regarding lump sum settlements Issue payments and request for reimbursement where claims for supplemental benefits are involved Review awards to ensure the correct recipient and rate of compensation Schedule or waive medical examinations as necessary Analyze medical bills to determine causality, levels of treatment, necessity for treatment, appropriateness of fees and procedure codes, and apportionment status Respond to requests for home modifications, home health care personnel, medication, and medical supplies and appliances Review case activity and determine when a claim can be retired Specific duties to be discussed at time of interview Minimum Qualifications For appointment via NY HELPS: To Trainee 1 Four years of experience* processing Workers Compensation or Disability Benefits including Paid Family Leave claims. To Journey Level Six years of experience* processing Workers Compensation or Disability Benefits including Paid Family Leave claims. For Competitive Appointment To Trainee 1 Transfer: 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: Assistant Insurance Fund Services Representative, Program Aide. To journey-level title: Transfer: One year of permanent, competitive class serv