State Workers' Insurance Fund Claims Adjuster

3 weeks ago

Lackawanna County PA, United States Commonwealth of PA Full time

**THE POSITION**:
Do you have experience investigating workers compensation claims? Are you organized, analytically minded, and looking for a new and exciting career change? If so, the State Workers' Insurance Fund (SWIF) has the perfect opportunity for you We are in search of a dedicated SWIF Claims Adjuster to join our team of professionals. This position is responsible for investigating, processing, and managing reported work-related claims or injuries for employees of policy holders for the purpose of determining compensability. Bring your talent and ambition to our department where you have the ability to make a difference in the lives of fellow Pennsylvanians

**DESCRIPTION OF WORK**:
In this role, you will be required to maintain a thorough knowledge and understanding of the established procedures as you monitor and control all aspects of claims submitted. Having a keen eye for detail is essential as you will be determining applicability of pre-existing conditions, identifying potential fraud, as well as verifying all information submitted is accurate. Strong critical thinking and decision-making skills are utilized to assess claims and provide the initial decision of acceptance or denial of a reported work-related claim. Effective communication is a key aspect of this position, as you will be contacting all appropriate parties related to the reported claim including the claimant, employers, doctors, hospitals, and witnesses to assist in eligibility determination for benefits. You will also have the opportunity to determine liability on medical bills and make determinations to identify potential fraud, which will be documented and reported to the SWIF fraud investigator and supervisor.

Interested in learning more? Additional details regarding this position can be found in the position description.

**Work Schedule and Additional Information**:

- Full-time employment
- Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with 30-minute lunch.
- ** Telework**:You may have the opportunity to work from home (telework) part-time. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Scranton.
- ** Salary**:_ _**In some cases, the starting salary may be non-negotiable.

**REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY**:
**QUALIFICATIONS**

**Minimum Experience and Training Requirements**:

- One year of experience as a SWIF Claims Representative (commonwealth title); **or**:

- One year of technical work in the processing, review, investigation, and payment of workers’ compensation insurance claims in the insurance industry; **or**:

- An equivalent combination of experience and training.

**Additional Requirements**:

- You must be able to perform essential job functions.

**How to Apply**:
**Veterans**:
**Telecommunications Relay Service (TRS)**:

- 711 (hearing and speech disabilities or other individuals).
- If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

Learn more about our Total Rewards by watching this short video

**Health & Wellness**

We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.*

**Compensation & Financial Planning**
We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options.
**Work/Life Balance**
We know there’s more to life than just work Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.*
**Values and Culture**
We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.
**Employee Perks**
Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships.

- Eligibility rules apply.

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