Review Vacancy
TitleClaims Services Representative 1
Occupational CategoryOther Professional Careers
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $56604 to $71980 Annually
Minimum Qualifications Reachable for appointment to Trainee 1 level on the current Civil Service eligible list used for filling this title; one year of permanent, competitive class service as a Claims Services Representative 1; or one year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Titles eligible for transfer include: Policyholder Services Representative 1, Underwriter 1, and Investigator 2 (Compensation Claims).
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.
Some positions may require additional credentials or a background check to verify your identity.
Address
Notes on ApplyingPlease include the position title, Vacancy ID number, and your current Civil Service title on your cover letter. Candidates should email resume and cover letter to hr@nysif.com. If necessary, candidates may also mail to 15 Computer Drive West, Albany, NY 12205 or fax to 518-437-1618.