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Claims Services Representative 1/Trainee 1/2
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Duties Description Under the general supervision of a Claims Services Representative 2 responsibilities include, but are not limited to:• Oversee all aspects of workers compensation claims processing from inception to closing• 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• Specific duties to be discussed at time of interview Minimum Qualifications For Appointment to Claims Services Representative Trainee 1:• 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• Four years of experience* processing Workers Compensation or Disability Benefits including Paid Family Leave claimsFor Appointment to Claims Services Representative Trainee 2:• One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Examples of eligible titles include but are not limited to: Administrative Specialist Trainee 2, Claims Services Representative DB Trainee 2, Underwriter Trainee 2; OR• Five years of experience* processing Workers Compensation or Disability Benefits including Paid Family Leave claimsFor Appointment to Claims Services Representative 1, SG-18:• One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Examples of eligible titles include but are not limited to: Administrative Specialist 1, Claims Services Representative 1 DB, Underwriter 1; OR• Six years of experience* processing Workers Compensation or Disability Benefits including Paid Family Leave claims*Substitution: An associate degree may substitute for two years of experience; a bachelor’s degree may substitute for four years of experience; a master’s degree may substitute for five years of experience; and a doctorate may substitute for six years of experience.Please be advised that the New York State Insurance Fund (NYSIF) 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. NYSIF is not currently enrolled in eVerify, which is a requirement for certain types of employment verifications. Some positions may require additional credentials or a background check to verify your identity.
