State Workers' Insurance Fund Claims Representative

Are you an analytically minded professional with a keen eye for detail? If so, consider joining the State Workers' Insurance Fund (SWIF) as a Claims Representative. This position gives you the opportunity to review and evaluate workers' compensation claims to ensure compliance with the applicable statute and claims administration practices. If you thrive on investigative work and providing excellent customer service, we want to hear from you!

As a Claims Representative, your work involves approving payment of medical-only claims and minor lost time/disability claims and identifying claims issues for referral or resolution. Responsibilities include contacting claimants, service providers, and other individuals to collect or provide information regarding the status of claims. This position makes the initial decision of approval or denial on a reported work-related claim within assigned authority level and processes acceptance or denial within the time frame prescribed by law. Following review and approval, you will make payments and contact appropriate parties regarding the status of the claim. You will have the opportunity to identify and make recommendations to supervisors and nursing staff for suspected excess use of medical treatments.

Interested in learning more? Additional details regarding this position can be found in the position description.

Work Schedule and Additional Information:

• Full-time employment
• Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with 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. The ability to telework is subject to change at any time.
• 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 possess 10 years of experience in a government administrative position which included clerical and customer service experience.
• 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:

• Pennsylvania law (51 Pa. C.S. *7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.pa.gov/agencies/employment/how-to-apply.html and click on Veterans.

Telecommunications Relay Service (TRS):

• 711 (hearing and speech disabilities or other individuals).

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.