Claims Services Representative 1 / Trainee 1 / 2 (Group 90) - NYHELPS

Claims Services Representative

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.
• Review case activity and determine when a claim can be retired.

Minimum Qualifications :

Please note, the salary range shown includes location pay. For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts.

Fringe Benefits :

NY HELPS Program :

This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS). For the duration of the NY HELPS Program, this title may be filled via a non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the title for which they apply. At a future date, it is expected employees hired under NY HELPS will have their non-competitive employment status converted to competitive status, without having to compete in an examination. Employees will then be afforded with all the same rights and privileges of competitive class employees of New York State. While serving permanently in a NY HELPS title, employees may take part in any promotion examination for which they are qualified.

NYSIF Commitment to Diversity, Equity, and Inclusion :

The New York State Insurance Fund (NYSIF) prioritizes and champions diversity, equity, and inclusion (DEI) throughout our agency. NYSIF provides equal opportunities to all employees and applicants for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability, veteran status, or any other protected category under federal, state, and local law. We believe that embracing our differences brings richness, new ideas and experiences to NYSIF, which energizes a creative and innovative work environment. We strive to foster a workplace where diverse individuals are able to participate fully in the decision-making process and have ample opportunity for advancement. We are committed to investing the necessary resources and attention to improving the engagement, retention, and promotion of the extraordinary talent we have.

Executive Order 31 commits New York State government to becoming a model employer for people with disabilities, increasing the participation of people with disabilities in state service and ensuring equal access to opportunities. NYSIF is proud to utilize best practices to recruit, hire, retain, and promote career advancement of individuals with disabilities. This includes special focus on current and prospective employees with the most significant disabilities, such as the use of supported employment, individual placement with support services, customized employment, the civil service sections 55 / b and 55 / c programs, internships, and job shadowing. If you are a person with a disability and wish to request that a reasonable accommodation be provided for you to participate in a job interview, please send an email to NYSIF's Reasonable Accommodations mailbox at ra@nysif.com.

Some positions may require additional credentials or a background check to verify your identity.