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Claims Services Representative 1/Trainee 1/Trainee 2

2 months ago

Buffalo, New York, United States New York State Insurance Fund Full time
Job Summary

The New York State Insurance Fund is seeking a highly skilled Claims Services Representative 1/Trainee 1/Trainee 2 to join our team. As a key member of our claims processing unit, you will be responsible for overseeing all aspects of workers' compensation claims processing from inception to closing.

Key Responsibilities
  • Initial determination of compensability and filing of documentation with the Workers Compensation Board (WCB)
  • Calculation and adjustment of reserves consistent with case analysis over the anticipated life of the claim
  • Recommendation of cases for appeal to WCB
  • Negotiation and/or recommendation of lump sum settlements
  • Issuance of payments and requests for reimbursement for supplemental benefits
  • Review of awards to ensure correct recipient and rate of compensation
  • Scheduling or waiving of medical examinations as necessary
  • Analysis of medical bills to determine causality, levels of treatment, necessity for treatment, appropriateness of fees and procedure codes, and apportionment status
  • Response to requests for home modifications, home health care personnel, medication, and medical supplies and appliances
  • Review of case activity and determination of when a claim can be retired
Requirements
  • 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
  • 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
Working Conditions

This position is located at the New York State Insurance Fund and requires a strong understanding of workers' compensation claims processing and regulations.

Salary Information

Minimum Salary: 49,363 Maximum Salary: 82,656 Salary Unit: Yearly