Workers' Compensation Examiner (NY HELPS), WCB Item #8940

Duties Description

Under the direction of a Senior Examiner, 18

Duties

The position of Workers Compensation Examiner would be assigned to the Financial Management section of the Special Funds group within Financial Services and would encompass but not be limited to the following duties:

• Review requests for medical and indemnity reimbursement against SDF claim records for proper application of apportionment and SDF liability;
• Review requests for medical and indemnity reimbursement against SDF claim records to ensure that no approved requests have already been paid, which would result in an overpayment to the insurance carrier or self-insured employer;
• Review requests for indemnity reimbursement against SDF claim records and CIS to ensure that appropriate payment rates are used to calculate reimbursement amounts;
• Review requests for indemnity reimbursement against CIS to validate other requested amounts (e.g.; Section 32s, lump sum payments) are appropriate for reimbursement;
• Review requests for medical reimbursement against SDF claim records to ensure only causally related treatment to established sites is approved for reimbursement;
• Review requests for medical reimbursement against the appropriate fee schedule to ensure that no more than the applicable amount is approved for reimbursement;
• Enter results of reimbursement review into tracking database and generate responses to insurance carriers or self-insured employers as necessary;
• Audit prior payments made per claim to identify potential overpayments that must be recouped and prepare calculation/documentation of any overpayment identified;
• Draft notification of overpayment recoupment for supervisory review and distribution to insurance carrier or self-insured employer;
• Update and maintain information in SDF claim records based on results of audits and reimbursement reviews;
• Assist with the organization and maintenance of medical reimbursement request forms, and provide OSC Audit with requested documentation as needed;
• Record direct payments from insurance carriers or self-insured employers, remitted to satisfy overpayments or third party pro rata shares in lieu of recoupment from reimbursement, in tracking database;
• Assist other sections within the Special Funds group with tasks or backlogs as needed, this may include, among other assignments, data entry, mail sorting or distribution, as well as review of claims files for settlement and hearing scheduling tasks;
• Assist with any special projects as assigned.
  
  

Minimum Qualifications

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 this time, agencies may recruit and hire employees by making permanent non-competitive appointments and the official probationary period will begin.

At a future date (within one year of permanent appointment), 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 of 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.

Non-competitive Minimum Qualifications

Candidates must have:

Either 1. Three years of full-time experience in a position where your primary responsibilities included extensive in-person or telephone customer service experience with the general public resolving customer's issues and/or problems; explaining programs/services, policies, or procedures; reconciling accounts; or experience examining, investigating, processing, or adjusting insurance claims; or responding to technical questions from policyholders or claimants;

Or 2. An associate's degree and two years of full-time experience described in #1;

Or 3. A bachelor's degree and one year of full-time experience described in #1

55 B/C Qualifications

Individuals certified eligible for the 55b/c program under the Governor’s Program to Hire Persons/Veterans with Disabilities pursuant to Section 55b/c of the Civil Service Law will also be considered. To be considered, you must meet the minimum qualifications and provide a copy of your letter of eligibility with your response.

Competitive Minimum Qualifications

CIVIL SERVICE LIST APPOINTMENT:

Candidates must be reachable on the appropriate Civil Service eligible list.

Transfer Qualifications

Candidates must have one year permanent or 55 b/c service in a title designated as appropriate for transfer in accordance with 70.1 of the Civil Service Law.

Additional Comments

Please Note: This position requires both in-office and remote work. A hybrid telecommuting schedule can be discussed with the hiring manager during the interview.

We offer a work-life balance and a generous benefits package, worth 65% of salary, including:

Holiday & Paid Time Off

• Thirteen (13) paid holidays annually.
• Thirteen (13) days of paid vacation leave in year one, increasing to 20 days with additional years of service.
• Five (5) days of paid personal leave annually.
• Thirteen (13) days of paid sick leave annually for PEF/CSEA and eight (8) days paid sick leave annually for M/C.
• Annual professional leave and educational leave opportunities for eligible staff.
  
  

Health Care Benefits

• Eligible employees and dependents can choose from a variety of affordable and generous health insurance programs.
• Family dental and vision benefits at no additional cost.
  
  

Additional Benefits

• Public Service Loan Forgiveness (PSLF).
• Enrollment in the New York State pension system which has earned the distinction of being one of the best-managed and best-funded plans in the nation OR Optional Retirement Defined Contribution Plan with 8% salary match (eligibility requirements apply).
• NYS Deferred Compensation and an exclusive 403(b) Optional Retirement Savings Plan.
• Paid Parental Leave for all employees and Paid Family Leave (M/C Only).
• Eligibility for various life insurance options.
• Access to NY 529 and NY ABLE College Savings Program
• Flexible Spending Program, which allows employees to set aside pre-tax payroll deductions for eligible health care and dependent care expenses.
  
  

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.

The Workers’ Compensation Board (Board) is an equal opportunity employer. The Board does not discriminate based upon age, race, creed, color, national origin, sexual orientation, gender identity or expression, religion, military or veteran status, sex, disability (including pregnancy-related conditions), predisposing genetic characteristics, familial status, marital status, status as a victim of domestic violence, or other applicable legally protected characteristics. The Board is dedicated to eliminating injustices and ensuring diversity in our workforce so we can better serve our staff and create a space where all feel safe to be themselves. To help meet those goals, we encourage applicants from marginalized communities to apply. We are looking for candidates who are committed to working in and contributing to an environment that fosters a sense of belonging, as well as inclusion, and celebrates people of all backgrounds, identities, experiences, and perspectives.

We are happy to provide reasonable accommodations during the hiring process. If you have a disability or special need that requires a reasonable accommodation, please send a request to officeofgeneralcounsel@wcb.ny.gov.