State Workers' Insurance Fund Claims Representative

Are you eager to start a new chapter in your career with the Commonwealth of Pennsylvania? If so, consider joining the Department of Labor & Industry, State Workers' Insurance Fund (SWIF) as a Claims Representative. This position gives you the opportunity to ensure compliance with applicable statute and claims administration practices, while approving payment claims and identifying claim issues. If you are an analytically minded professional with a keen eye for detail, we need you on our team!

As a Claims Representative, you will be tasked with completing investigations for reported incidents and claims as well as processing acceptance or denial within an established timeframe. Work involves determining if pre-existing conditions may impact a claim; identifying potential fraud; and making recommendations if excess use of physical therapy or medical equipment is identified. Effective communication is essential as you will have the opportunity to correspond with with claimants, employers, doctors, hospitals, and witnesses to determine eligibility for workers' compensation benefits. You will also be responsible for monitoring claims, creating fact-based claims, and accurately completing all required forms. Additional responsibilities include:

• Recommending use of Independent Medical Examinations (IME)
• Issuing ongoing indemnity payments
• Determining liability on all medical bills
• Processing claim payment related vouchers

Take your career up a notch with the SWIF Wilkes-Barre & Scranton District Office!

Work Schedule and Additional Information:

• Full-time employment
• Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.
• Telework: You may have the opportunity to work from home (telework) part-time. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Scranton.
• Salary: In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

QUALIFICATIONS

Minimum Experience and Training Requirements:

• Two years of clerical work experience that includes collecting, recording, compiling, or preparing documents for medical, health, or work-related insurance claims; or
• An equivalent combination of experience and training.

Additional Requirements:

• You must have at least 15 years of experience processing claims.
• You must have at least 15 years of experience in customer service.
• You must demonstrate the ability to adhere to the values and ethics of the Department of Labor and Industry.
• You must demonstrate the ability to work with professionalism, discretion, and good work ethic.
• You must have solid written and verbal communication skills.
• You must show initiative and problem-solving skills.
• You must be able to perform essential job functions.

How to Apply:

• Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
• If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
• Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
• Failure to comply with the above application requirements may eliminate you from consideration for this position.

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.