What are the responsibilities and job description for the Claims Services Representative 1 Trainee 1/Trainee 2 position at Insurance Fund, State?
The duties that the incumbent of the vacancy will be expected to perform. Duties Description Responsibilities include, but are not limited to: Under the general supervision of a Claims Services Representative 2, the incumbent will oversee all aspects of workers compensation claims processing from inception to closing; initially determine the compensability of claims and files 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; negotiate billing adjustments with medical care providers and suppliers applying workers compensation fee schedules and rules; identify and initiate referrals to the Legal Department; and review case activity to determine when a claim can be retired.Specific duties to be discussed at time of interview.
The minimum qualifications required for this vacancy. Minimum Qualifications For Appointment to Claims Services Representative 1, SG-18:•Reachable on current Civil Service eligible list for this title; OR•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: Administrative Specialist 1, Investigator 2 (Compensation Claims), Policyholder Services Representative 1, Underwriter 1, Underwriter 1 (Disability Benefits); OR•A bachelor’s or higher degree AND two years of New York State workers’ compensation claims adjustor experience; OR •A juris doctor, master’s or higher degree in a field related to the position being filled AND one year of New York State workers’ compensation claims adjustor experienceFor Appointment to Claims Services Representative Trainee 1:•Reachable on current Civil Service eligible list for this title; OR•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•A bachelor's or higher degree (in any area of study)Candidates with a score of 100 or higher on the current PCO eligible list who are eligible for appointment are encouraged to apply. Please note your score of this exam in your cover letter.Please be advised that the New York State Insurance Fund does not offer sponsorship for employment visas to employees or potential employees. Candidates sponsored for employment by an organization should be aware of their sponsorship status and the relevant expiration date(s) of that sponsorship before applying to this position.
Additional comments regarding the vacancy. Additional Comments 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.Fringe Benefits: • Competitive Compensation.• Future Career Growth Potential. • Open and Supportive Team-Based Environment.• Plentiful Vacation, Personal, and Sick Leave Accruals. • Paid State and Federal Holidays.• Full Medical, Vision, and Dental. • Retirement Options. • Public Student Loan Forgiveness (PSLF).• Possibility of Telecommuting, Flextime, and Alternative Work Schedules.NY HELPS Program: 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 a future date, 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 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.NYSIF Commitment to Diversity, Equity, and InclusionThe New York State Insurance Fund (NYSIF) prioritizes and champions diversity, equity, and inclusion (DEI) throughout our agency. NYSIF provides equal opportunities to all employees and applicants for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability, veteran status, or any other protected category under federal, state, and local law. We believe that embracing our differences brings richness, new ideas and experiences to NYSIF, which energizes a creative and innovative work environment. We strive to foster a workplace where diverse individuals are able to participate fully in the decision-making process and have ample opportunity for advancement. We are committed to investing the necessary resources and attention to improving the engagement, retention, and promotion of the extraordinary talent we have.Executive Order 31 commits New York State government to becoming a model employer for people with disabilities, increasing the participation of people with disabilities in state service and ensuring equal access to opportunities. NYSIF is proud to utilize best practices to recruit, hire, retain, and promote career advancement of individuals with disabilities. This includes special focus on current and prospective employees with the most significant disabilities, such as the use of supported employment, individual placement with support services, customized employment, the civil service sections 55/b and 55/c programs, internships, and job shadowing. If you are a person with a disability and wish to request that a reasonable accommodation be provided for you to participate in a job interview, please send an email to NYSIF’s Reasonable Accommodations mailbox at ra@nysif.com.
Some positions may require additional credentials or a background check to verify your identity.
The minimum qualifications required for this vacancy. Minimum Qualifications For Appointment to Claims Services Representative 1, SG-18:•Reachable on current Civil Service eligible list for this title; OR•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: Administrative Specialist 1, Investigator 2 (Compensation Claims), Policyholder Services Representative 1, Underwriter 1, Underwriter 1 (Disability Benefits); OR•A bachelor’s or higher degree AND two years of New York State workers’ compensation claims adjustor experience; OR •A juris doctor, master’s or higher degree in a field related to the position being filled AND one year of New York State workers’ compensation claims adjustor experienceFor Appointment to Claims Services Representative Trainee 1:•Reachable on current Civil Service eligible list for this title; OR•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•A bachelor's or higher degree (in any area of study)Candidates with a score of 100 or higher on the current PCO eligible list who are eligible for appointment are encouraged to apply. Please note your score of this exam in your cover letter.Please be advised that the New York State Insurance Fund does not offer sponsorship for employment visas to employees or potential employees. Candidates sponsored for employment by an organization should be aware of their sponsorship status and the relevant expiration date(s) of that sponsorship before applying to this position.
Additional comments regarding the vacancy. Additional Comments 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.Fringe Benefits: • Competitive Compensation.• Future Career Growth Potential. • Open and Supportive Team-Based Environment.• Plentiful Vacation, Personal, and Sick Leave Accruals. • Paid State and Federal Holidays.• Full Medical, Vision, and Dental. • Retirement Options. • Public Student Loan Forgiveness (PSLF).• Possibility of Telecommuting, Flextime, and Alternative Work Schedules.NY HELPS Program: 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 a future date, 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 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.NYSIF Commitment to Diversity, Equity, and InclusionThe New York State Insurance Fund (NYSIF) prioritizes and champions diversity, equity, and inclusion (DEI) throughout our agency. NYSIF provides equal opportunities to all employees and applicants for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability, veteran status, or any other protected category under federal, state, and local law. We believe that embracing our differences brings richness, new ideas and experiences to NYSIF, which energizes a creative and innovative work environment. We strive to foster a workplace where diverse individuals are able to participate fully in the decision-making process and have ample opportunity for advancement. We are committed to investing the necessary resources and attention to improving the engagement, retention, and promotion of the extraordinary talent we have.Executive Order 31 commits New York State government to becoming a model employer for people with disabilities, increasing the participation of people with disabilities in state service and ensuring equal access to opportunities. NYSIF is proud to utilize best practices to recruit, hire, retain, and promote career advancement of individuals with disabilities. This includes special focus on current and prospective employees with the most significant disabilities, such as the use of supported employment, individual placement with support services, customized employment, the civil service sections 55/b and 55/c programs, internships, and job shadowing. If you are a person with a disability and wish to request that a reasonable accommodation be provided for you to participate in a job interview, please send an email to NYSIF’s Reasonable Accommodations mailbox at ra@nysif.com.
Some positions may require additional credentials or a background check to verify your identity.
