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Associate Claims Examiner

3 months ago

Windsor Locks, United States State of Connecticut Full time
Introduction

The Office of the State Treasurer exists to provide and ensure effective financial management of public resources, high standards of professionalism and integrity, and expanding opportunity for State of Connecticut residents and businesses.

We are recruiting for two (2) Associate Claims Examiner to support the Unclaimed Property Division.

POSITION HIGHLIGHTS:

  • Full Time, 40 hours per week
  • 1st Shift, Monday - Friday
  • Centrally located in downtown Hartford, close to major highways
ABOUT THIS ROLE:
  • Independently responsible for processing highly complex claims for validity, legality and subsequent approval of claim for payment;
  • Reads, interprets and applies office guidelines, processes and internal controls to process claims;
  • Examines all supporting documents for validity, this may include a variety of source documents from federal, state or local governments, businesses or financial institutions;
  • Responsible for performing complex calculations to determine total value of claims prior to approval for payment;
  • Researches and evaluates securities, mutual funds or bonds to verify history and activity;
  • Calculates the value of such securities, mutual funds or bonds and ensures dividends or corporate actions are appropriately applied as mandated by state law;
  • Determines if additional evidence is required to process claims, writes letters to request additional information;
  • Identifies and resolves disputed claims; contacts other state offices or businesses to confirm accuracy of information prior to approval of claim; receives and responds to telephone calls and written correspondence received;
  • Maintains claim pending processing and claims awaiting additional information in separate numeric filing systems;
  • Denies claims if supporting source documentation shows discrepancy of reported information;
  • Maintains proper accounting of paid claims and payment authorization of claims;
  • Operates general office equipment;
  • Will maintain general knowledge of a variety of computer systems;
  • May prepare reports and general correspondence; performs related duties as required.
Selection Plan

In order to be considered for this job opening you must be a current State of CT employee of the agency listed above for at least six (6) months of full-time service or full-time equivalent service, absent any applicable collective bargaining language, and meet the Minimum Qualifications as listed on the job opening. You must specify your qualifications on your application.

For current state employees, salary calculations are not necessarily comparable from one of the three branches of state government (i.e., Executive, Legislative, Judicial) to the other.

In order to comply with Public Act 21-69, the State of Connecticut is no longer asking for resumes during the initial application process. Please ensure that your application is complete prior to submitting.

NOTE: At any point during the recruitment process, applicants may be required to submit additional documentation which support their qualification(s) for this position. These documents may include: a cover letter, resume, performance reviews, supervisory references, attendance records, etc., at the discretion of the hiring agency. Should you have questions pertaining to any phase of this recruitment, please contact Josh Lelyveld, josh.lelyveld@ct.gov.

This posting may require completion of additional referral questions (RQ's) which will be sent to you via email after the closing date. Please regularly check your email for notifications, including your SPAM/JUNK folders. You must reply by the deadline indicated on the notification or you will be automatically disqualified from consideration.

Interviews will be limited to candidates whose experience and training most closely meet the requirements and preferred qualifications of the position.

All application materials must be received by the recruiting agency by the time specified on the job opening for the position for which you are applying. Late applications may not be submitted and will not be considered. Exceptions are rare and limited to documented events that incapacitate a candidate during the entire duration of the job posting time period. It is the candidate's obligation and responsibility to request an exception and provide a legally recognized justification to accommodate such exception. Requests should be made to das.shrm@ct.gov.

PURPOSE OF JOB CLASS (NATURE OF WORK)

DEPARTMENT OF SOCIAL SERVICES AND OFFICE OF THE TREASURER: This class is accountable for performing the most complex tasks related to the examination of claims and supporting documentation for validity, legality and subsequent approval for payment.

OFFICES OF POLICY AND MANAGEMENT [INTERGOVERNMENTAL RELATIONS DIVISION] AND STATE COMPTROLLER: This class is accountable for acting as a working supervisor for Claims Examiners engaged in examining claims and supporting documentation for validity, legality and subsequent approval for payment.

EXAMPLES OF DUTIES

OFFICE OF THE TREASURER:
  • Performs specialized duties related to examination of claims for purposes of returning people to work, negotiating settlements and uncovering fraud;
  • Develops or assists in development of indemnity and medical reserves as well as reserve reassessment based upon new information or a change in circumstance;
  • Develops and implements claim file action plan by interpreting medical reports and utilizing in-house and outside resources including but not limited to independent medical evaluations, surveillance, Attorney General referral and/or vocational assistance;
  • Identifies and resolves disputed issues pursuant to Connecticut General Statute Chapter 568;
  • Prepares for and attends Workers Compensation hearings as needed;
  • Performs related duties as required.
KNOWLEDGE, SKILL AND ABILITY
  • Knowledge of
    • relevant state laws and regulations;
    • auditing and record keeping procedures;
    • reserving techniques;
  • Skills
    • interpersonal skills;
    • oral and written communication skills;
    • negotiation skills;
    • analytical skills;
    • performing arithmetical computations skills;
  • Ability to
    • read, understand and apply laws and regulations;
    • examine and analyze highly complex claims;
    • schedule and prioritize workflow;
    • operate office equipment;
    • operate office suite software;
  • Supervisory ability.
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE

Five (5) years of experience in highly complex clerical work involving financial record keeping, auditing, accounting, purchasing or claim processing.

NOTE: For state employees this experience is interpreted at the level of Financial Clerk.

MINIMUM QUALIFICATIONS - SPECIAL EXPERIENCE

One (1) year of the General Experience must have included accounts payable and/or claims auditing.

MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED
  • College training may be substituted for the General Experience on the basis of fifteen (15) semester hours equalling one-half (1/2) year of experience to a maximum of four (4) years for a Bachelor's degree.
  • One (1) year as a Claims Examiner may be substituted for the General and Special Experience.
  • Possession of a current State of Connecticut Workers Compensation Casualty Adjuster License may be substituted for one (1) year of the General Experience.
PREFERRED QUALIFICATIONS

Preference will given to candidates with the following experience/training:
  • Minimum of two years of experience drafting, preparing and sending letters or responses to customers, personnel, or claimants' requests for additional information or relaying information or denials about related matters.
  • Proven track record of learning new tasks and independently and efficiently completing complex work.
  • Proven experience using and retrieving information from complex databases such as Core, KAPS, Microsoft Office applications, or SalesForce.
  • Experience independently reading, interpreting and appropriately applying particular guidelines and internal controls while processing and approving claims.
  • Two or more years of experience independently processing claims or similarly complex processes for legitimacy, compliance with rules, regulations, state laws, and applying office policies to either approve or deny claims.
  • A minimum of six months' satisfactory experience independently reviewing documents submitted for a claim:(examples of documents to be reviewed include, but are not limited to: corporate subsidiary listings, trusts, wills, power of attorney, beneficiary or custodial accounts, estate, conservatorship or guardianship documents from Probate Court, divorce decrees, third-party contracts, bankruptcy documents, healthcare claims, or similarly complex documents).


Conclusion

AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER

The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.

ACKNOWLEDGEMENT

As defined by Sec. 5-196 of the Connecticut General Statutes, a job class is a position or group of positions that share general characteristics and are categorized under a single title for administrative purposes. As such, a job class is not meant to be all-inclusive of every task and/or responsibility.