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New York State Insurance Fund (NYSIF) · 7 hours ago

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

White Plains, NY

Full-time

Onsite

Entry Level

$58K/yr - $89K/yr

4+ years exp

New York State Insurance Fund (NYSIF) is seeking a Claims Services Representative to oversee workers compensation claims processing. The role involves determining claim compensability, negotiating settlements, and managing case activity from inception to closure.

ConsultingFinancial ServicesInsurance

No H1B

Responsibilities

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

Respond to requests for home modifications, home health care personnel, medication, and medical supplies and appliances

Review case activity and determine when a claim can be retired

Specific duties to be discussed at time of interview

Qualification

Workers Compensation processingDisability Benefits processingClaims analysisNegotiation skillsCommunication skills

Required

One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Investigator 1, Assistant Insurance Fund Services Representative, Program Aide; OR

Four years of experience processing Workers Compensation or Disability Benefits including Paid Family Leave claims

One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Examples of eligible titles include but are not limited to: Administrative Specialist Trainee 2, Claims Services Representative DB Trainee 2, Underwriter Trainee 2; OR

Five years of experience processing Workers Compensation or Disability Benefits including Paid Family Leave claims

One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Examples of eligible titles include but are not limited to: Administrative Specialist 1, Claims Services Representative 1 DB, Underwriter 1; OR

Six years of experience processing Workers Compensation or Disability Benefits including Paid Family Leave claims

An associate degree may substitute for two years of experience; a bachelor's degree may substitute for four years of experience; a master's degree may substitute for five years of experience; and a doctorate may substitute for six years of experience