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WCC CLAIMS ANALYST

The Workers’ Compensation Commission (WCC) Claims Analyst is responsible for investigating and determining public employees’ eligibility for Workers’ Compensation benefits and authorizing the payment

Class Code:

G201C

Job Grade:

GS05

Special Job Requirements:

0

Typical Functions:

Investigates Workers’ Compensation accident claims filed by public employees by reviewing submitted documentation, interviewing and documenting statements of claimants, supervisors, and witnesses to the accident, researching laws and related regulations, and obtaining medical information. Determines eligibility for Workers’ Compensation benefits, submits case to supervisor for review and approval, and notifies all parties of determination. Files determination with Workers’ Compensation Commission and maintains and reviews case files. Initiates payment of benefits and attorney’s fees and audits medical providers’ invoices for reasonableness and relationship to injury. Prepares settlements on disputed claims. Assists legal staff with litigation, if necessary, by providing attorneys with all case information and testifying at hearings. Provides technical assistance to employers by conducting training sessions explaining Workers’ Compensation provisions, regulations, and procedures and answering specific questions. Identifies possible subrogation claims by investigating third party liability and initiating recovery procedures. Performs other duties as assigned.

Knowledge, Abilities, and Skills:

Knowledge of the Workers’ Compensation Act and relating claims provisions and procedures. Knowledge of insurance claims processing procedures. Knowledge of supervisory practices and techniques. Ability to investigate, determine, and initiate payment of Workers’ Compensation claims. Ability to prepare and present oral and written information and reports. Ability to interpret and explain Workers’ Compensation provisions, procedures, and regulations. Ability to oversee the work of others.

Minimum Qualifications:

The formal education equivalent of an associate’s degree in business management, office administration, health science, or a related field; plus three years of experience in processing insurance or other benefit claims or a related field.

Required Certificates:

0

Exempt:

N
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