WORKERS' COMPENSATION CLAIMS EXAMINER 0945

DISTINGUISHING FEATURES OF THE CLASS

An employee in this class performs difficult examining work in a Workers' Compensation claims unit. Responsibility is included for making an initial determination to accept or controvert a claim by applying guidelines established by New York State Workers' Compensation laws and procedures, and for explaining regulations and procedures to employees and department administrators. Work requires considerable initiative and judgment and is performed under general technical or administrative supervision. Does related work as required.

TYPICAL WORK ACTIVITIES

Reviews initial paperwork submitted for potential Workers' Compensation claims and, applying New York State Workers' Compensation laws and regulations, determines whether to accept or controvert a claim;

Processes and maintains complex Workers' Compensation records;

Authorizes payments of medical bills and treatments for those not yet on a Workers' Compensation payroll;

Reviews claims to assure that payments requested are related to the original incident, that treatments are within allowable limits and that authorizations are in place;

Assures that files are complete and that all necessary supporting material has been received;

Explains Workers' Compensation regulations and procedures to affected employees and department administrators;

Advises department representatives, consultants, rehabilitation professionals, investigators, employees, doctors, union representatives and attorneys regarding claims;

Computes and analyzes lump sum payments and third party deficiency compensation claims;

Assists in identifying possible fraudulent claims;

Assists the Workers' Compensation Supervisor in the application of Workers' Compensation Board decisions.

FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS

Good knowledge of Workers' Compensation laws, regulations and rates of payment; good knowledge of procedures for processing claims, payments and reimbursements and for controverting claims; some knowledge of the legal aspects of Workers' Compensation claims; ability to evaluate claims by applying appropriate laws, rules and regulations; ability to perceive illegitimate claims and/or disqualifying conditions needing further investigation or examination; ability to deal effectively with others; ability to maintain accurate records and files of claims and supporting documentation; ability to express oneself clearly and concisely both orally and in writing; good powers of observation and perception; tact and good judgment; physical condition commensurate with the demands of the position.

MINIMUM QUALIFICATIONS

OPEN COMPETITIVE

Graduation from high school or possession of a high school equivalency diploma and three (3) years of experience in applying Workers' Compensation rules and regulations in the review and processing of claims.

NOTE: Additional education from college with federally-authorized accreditation or registration by NY State may be substituted for up to two (2) years of the above experience.

R12/23/02

SUFFOLK COUNTY

Competitive