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Claims Services Representative 1/Trainee 1/Trainee 2

2 months ago


Buffalo, New York, United States StateJobsNY Full time
Job Summary

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

Key Responsibilities
  • 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 requests 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
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
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
Commitment to Diversity, Equity, and Inclusion

The New York State Insurance Fund (NYSIF) prioritizes and champions diversity, equity, and inclusion (DEI) throughout our agency. We believe that embracing our differences brings richness, new ideas and experiences to NYSIF, which energizes a creative and innovative work environment.