Title: Senior Claims Examiner

State Role Title: Senior Claims Examiner

Hiring Range: Minimum starting salary of $49,842 commensurate with experience

Pay Band: UG

Agency: VA Workers' Compensation Comm

Location: RICHMOND HEADQUARTERS

Agency Website: https://workcomp.virginia.gov/

Recruitment Type: Agency Employee Only - A

This position is open to current VA Worker's Compensation team members only.

Job Duties

The Virginia Workers' Compensation Commission, an independent State agency, seeks two Senior Claims Examiners to independently manage a caseload of complex and specialized claims. These positions manage claims from beginning to end by analyzing all necessary documentation to determine eligibility and compensability under the Code of Virginia and CICF policies. Senior Claims Examiners also assesses medical records, billing statements, collateral resources, court records and employment information to determine whether expenses are allowable for reimbursement and performs routine follow-up until all issues have been resolved.

Additional responsibilities include examining and determining the appropriate award amount; assisting Team Leads with daily reports, training, and customer service concerns; and supporting CICF’s mass casualty responsibilities and operations as needed. Must past criminal background check. 
VWC Compensation Structure
Virginia Workers' Compensation Commission is an independent agency which allows us to have a more competitive and unique pay structure. This position is a pay grade 6 based on a 14 grade pay structure. Our positions are not classified under DHRM's pay bands.
Telework Structure
Our agency is currently using a hybrid model for teleworking. Our positions at this time are not 100% teleworking. All candidates would be expected to report to our Headquarters/Regional Office as requested. Telework scheduling is at the discretion of the Director/Manager based on the business needs of the department. Upon hire, candidates should expect to have all training and orientation conducted at the Headquarters Office.
Virginia Workers’ Compensation Commission Overview:
Led by a Senior Leadership team consisting of three Commissioners, an Executive Director and a Chief Deputy Commissioner, Virginia Workers’ Compensation Commission was recently recognized as a Top Workplace for 2023 - 2024 in the Richmond region and in the USA! Our mission is to serve injured workers, victims of crimes, employers, and related industries by providing exceptional services, resolving disputes, and faithfully executing the duties entrusted to us by the Commonwealth of Virginia. Our vision is to lead the nation as the most effective and innovative state agency. VWC employees demonstrate seven core values: innovation, respect, accountability, reliability, impartiality, integrity, and effectiveness.
We are a “Virginia Values Veterans” (V3) official certified state agency that supports Veterans and Members of the Reserves and/or National Guard. If you are a Veteran or Spouse of a Veteran or Active Military Member, we urge you to respond accordingly on your state application. Virginia Workers’ Compensation Commission is an Equal Opportunity Employer and we encourage diversity within our workforce. Virginia Workers’ Compensation Commission does not provide sponsorship for employment.
VWC is the recipient of the following awards:

• 2022 - 2024 Top USA Workplace
• 2021 - 2023 Top Workplace Richmond Region
• 2023 Top Award for Mid-Sized Companies
• 2022 - 2023 Doers Award

Minimum Qualifications

• Significant experience providing high-volume case management in a fast-paced, criminal justice, human services, or related environment required
• Comprehensive experience with victim compensation claims
• Experience interacting with a diverse group of professionals and customers via oral and written communication
• Experience gathering, entering, and updating information and creating and presenting reports
• Significant experience providing high-volume case management in a fast-paced environment.
• Extensive knowledge of how to process compensation claims under the Virginia Criminal Injuries Compensation Fund Act.
• Ability to manage large caseload of compensation claims and meet deadlines.
• Exceptional analytical and logical reasoning and administrative research skills and abilities
• Strong work ethic and attention to detail
• Demonstrated ability to work within deadlines in a high volume, fast-paced environment and exercise good judgment
• Demonstrated ability to work both independently and as part of a team
• Working knowledge of Virginia's criminal justice system and/or criminal code, medical billing processes, victims' issues, and the collateral resources available to victims
• Working knowledge of criminal justice processes and the impact of trauma
• Proficiency with Microsoft Office applications including Word, Outlook, Power Point, and Excel; data entry and retrieval from computer databases; and Internet research principles
• Ability to travel overnight on occasion

Additional Considerations

• Experience mentoring, training, and/or coaching preferred
• Experience with CICF, VWC, and/or LOPAS databases preferred

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

Contact Information

Name: Amy Habel

Phone: (804) 205-3571

Email: vwcjobs@workcomp.virginia.gov

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.