Claims Services Representative 1/Trainee 1/Trainee 2 (NY HELPS)
: Job Details :

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, butare 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 New York State workers' compensation claims adjustor experience; OR • A juris doctor, master's or higher degree in a field related to the position being filled AND one year of New York State workers' compensation claims adjustor experience.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).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 Oversees all aspects of workers' compensation claims processing from inception to closing; reviews individual claims for workers' compensation and determines claimant's eligibility for benefits; initially determines the compensability of claims by examining medical reports from physicians, hospitals, and medical labs; files appropriate documentation with the Workers' Compensation Board (WCB); clarifies any issues either by written or telephone communication with claimants and employers; establishes the adequacy of medical information and documentation to determine the extent of the claimant's work-related disability; calculates and adjusts reserves consistent with case analysis over the anticipated life of the claim; recommends cases for appeal to the WCB; negotiates settlements; reviews facts of disputed cases to determine the legal basis of controversy; obtains pertinent vocational information from employers and safety groups/brokers; reviews payroll records to calculate claimants' average weekly wages and compensation rates; 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; alerts Claims Services Representatives 2 if fraud is suspected and arranges for surveillance before and after an independent medical exam; analyzes medical bills to determine causality, levels of treatment, necessity for treatment, appropriateness of fees and procedure codes, and apportionment status. Refers to the Medical Treatment Guidelines manual to confirm treatment compliance and approve medical treatment authorization requests; negotiates billing adjustments with medical care providers and suppliers applying workers' compensation fee schedules and rules; audits claimant reimbursement requests for causally-related medical and travel expenses; determines employer witnesses and files pre-hearing conference statements outlining the factual and legal basis of the case before referring cases to the Legal Department; and reviews case activity and determines when a claim can be retired.Specific duties to be discussed at time of interview. Additional Comments Please note, the salary range shown includes location pay and/or geographic pay. For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts.Fringe Benefits: • Competitive Compensation.• Future Career Growth Potential. • Open and Supportive Team-Based Environment.• Plentiful Vacation, Personal, and Sick Leave Accruals. • Paid State and Federal Holidays.• Full Medical, Vision, and Dental. • Retirement Options. • Possibility of Telecommuting, Flextime, and Alternative Work Schedules.(If applicable) NY HELPS Program:This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS). For the duration of the NY HELPS Program, this title may be filled via a non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the title for which they apply. At a future date, it is expected employees hired under NY HELPS will have their non-competitive employment status converted to competitive status, without having to compete in an examination. Employees will then be afforded with all the same rights and privileges of competitive class employees of New York State. While serving permanently in a NY HELPS title, employees may take part in any promotion examination for which they are qualified.NYSIF Commitment to Diversity, Equity, and InclusionThe New York State Insurance Fund (NYSIF) prioritizes and champions diversity, equity, and inclusion (DEI) throughout our agency. NYSIF provides equal opportunities to all employees and applicants for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability, veteran status, or any other protected category under federal, state, and local law. We believe that embracing our differences brings richness, new ideas and experiences to NYSIF, which energizes a creative and innovative work environment. We strive to foster a workplace where diverse individuals are able to participate fully in the decision-making process and have ample opportunity for advancement. We are committed to investing the necessary resources and attention to improving the engagement, retention, and promotion of the extraordinary talent we have.Executive Order 31 commits New York State government to becoming a model employer for people with disabilities, increasing the participation of people with disabilities in state service and ensuring equal access to opportunities. NYSIF is proud to utilize best practices to recruit, hire, retain, and promote career advancement of individuals with disabilities. This includes special focus on current and prospective employees with the most significant disabilities, such as the use of supported employment, individual placement with support services, customized employment, the civil service sections 55/b and 55/c programs, internships, and job shadowing. If you are a person with a disability and wish to request that a reasonable accommodation be provided for you to participate in a job interview, please send an email to NYSIF's Reasonable Accommodations mailbox at ...@nysif.com. Some positions may require additional credentials or a background check to verify your identity.Name Khalan Cassala Telephone Fax Email Address ...@nysif.com AddressStreet PO BOX 66699 City Albany State NY Zip Code 12206 Notes on Applying Candidates should email resume and cover letter to ...@nysif.com. Please include the position title, Vacancy ID number, and your current Civil Service title on your cover letter.