State Workers' Insurance Fund Claims Adjuster

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!

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

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:

• One year of experience as a SWIF Claims Representative (commonwealth title); or
• One year of technical work in the processing, review, investigation, and payment of workers' compensation insurance claims in the insurance industry; or
• An equivalent combination of experience and training.

Additional Requirements:

• You must demonstrate the ability to adhere to the values and ethics of the Department of Labor & Industry.
• You must demonstrate the ability to work with professionalism, discretion, and good work ethic.
• You must possess solid written and verbal communication skills.
• You must demonstrate initiative and problem-solving skills.
• You must have at least five years of experience with the following Social Security Administration duties:
  • Process of appeals
  • Paybacks and overpayments
  • Identification of fraud
  • ORM enrollment and termination
  • Part A and B of Medicare
• You must be able to perform essential job functions.

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:

• 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.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans' Preference tab or contact us at ra-cs-vetpreference@pa.gov.

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.