Review Vacancy
TitleClaims Services Representative 1
Occupational CategoryOther Professional Careers
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $52293 to $66494 Annually
Minimum Qualifications YOU MUST BE A CURRENT STATE EMPLOYEE TO BE ELIGIBLE FOR APPOINTMENT TO THIS POSITION.
Claims Services Representative 1 Grade 18: Eligible for transfer under Section 70.1 of the Civil Service Law, having one year of permanent competitive service in an appropriate title. Appropriate titles include but are not limited to:
Compensation Claims Investigator SG-18, Policyholder Services Representative 1 SG-18, Underwriter 1.
Duties Description under the general supervision of a Claims Services Representative 2, oversees all aspects of workers compensation and disability benefits claims processing from inception to closing; initially determines the compensability of claims and files appropriate documentation with the Workers Compensation Board (WCB); calculates and adjusts reserves consistent with case analysis over the anticipated life of the claim; recommends cases for appeal to WCB; negotiates and/or makes recommendations regarding lump sum settlements; issues payments and requests for reimbursement where claims for supplemental benefits are involved; reviews awards to ensure the correct recipient and rate of compensation; schedules or waives medical examinations as necessary; analyzes medical bills to determine causality, levels of treatment, necessity for treatment, appropriateness of fees and procedure codes, and apportionment status; responds to requests for home modifications, home health care personnel, medication, and medical supplies and appliances; negotiates billing adjustments with medical care providers and suppliers applying workers compensation fee schedules and rules; identifies and initiates referrals to the Legal Department; and reviews case activity and determines when a claim can be retired.
Additional Comments YOU MUST BE A CURRENT STATE EMPLOYEE TO BE ELIGIBLE FOR APPOINTMENT TO THIS POSITION.
Some positions may require additional credentials or a background check to verify your identity.