What are the responsibilities and job description for the State Workers' Insurance Fund Claims Adjuster position at Commonwealth Of Pennsylvania?
THE POSITION
The Department of Labor & Industry, State Workers' Insurance Fund (SWIF) is seeking an individual with exceptional analytical and attention to detail skills as a SWIF Insurance Fund Claims Adjustor. In this role, you will have the opportunity to investigate, process, and manage reported work-related claims and injuries for employees of policy holders for the purpose of determining compensability. Apply today and become a part of our dedicated and valued team!
DESCRIPTION OF WORK
As a SWIF Claims Adjuster, you will be responsible for ongoing monitoring and controlling all aspects of the claim to conclusion in accordance with established procedures. Your time management skills will be key as you complete investigation for reported incidents or claims within 48 hours of receipt of the claim assignment and processes acceptance or denial within the time frame as prescribed by law. You will make determinations relating to pre-existing conditions, potential fraud, and return to work plans. Intake data must be complete, accurate, and included in claim files. You may be required to contact appropriate parties related to the reported claim including claimant, employers, doctors, hospitals, and witnesses to determine eligibility for workers' compensation benefits.
Other duties to include but not limited to :
- Managing and monitoring claims on a continual basis to resolve ongoing exposures
- Recognizing the need for filing of Utilization Review and referring to medical staff for review
- Creating fact-based claim reserves within authority level with proper file documentation
Interested in learning more? Additional details regarding this position can be found in the position description .
Work Schedule and Additional Information :
REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY
QUALIFICATIONS
Minimum Experience and Training Requirements :
Additional Requirements :
Process of appeals
Commonwealth employees who wish to use their seniority rights must apply to the internal posting for their seniority rights to be considered.
How to Apply :
Veterans :
Telecommunications Relay Service (TRS) :
If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.
The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.
