Workers' Compensation Examiner, WCB Item #8194

Under the direction of the Senior Workers' Compensation Examiner within the Office of General Counsel’s Adjudication Services Bureau, the Workers' Compensation Examiner duties will include but not limited to:

• Reviews all case activity, and appropriately routing issues disputes, supports the adjudication of claims; ensures compliance with applicable laws, rules, and regulations.
• Reopens inactive or closed claims to resolve new issues, requests meetings or hearings, ensures that a claims case is ready for the judge’s review, and ensures employers and payers are in compliance with the applicable laws, rules, and regulations.
• Reviews claims case file to determine if required forms and documents have been received; requests missing information from appropriate party; may prepare claims file, and if applicable according to specified criteria, prepares administrative decision for judges’ approval or prepares the file for presentation to judge for action.
• Processes judges' decisions and explains decisions to claimants, responds to questions and provides information on appeal procedures to claimants, employers, insurance carriers and attorneys, and reviews requests for appeal or reopening of a closed case to resolve new issues.
• Maintains the calendar and the schedule of the Senior Judge and the judges including hearings, conferences and meetings.
• Receives, reviews, organizes, and processes correspondences, court filings, notices, and other legal documents.
• Prepares, types, proofreads, and distributes memoranda, notices, reports, and correspondences.
• Maintains confidential case files, records, and administrative materials in accordance with Board's procedures and policies.
• Answers telephones and responds to inquiries from attorneys, claimants, carriers, and members of the public.
• Coordinates communication between adjudication, attorneys, and the parties.
• Assists in preparing calendar coverage assignments, PHC charts and any other materials for hearings.
• Inputs, retrieves, and updates information using the CIS and other Board's software applications.
• Schedules appointments and meetings and arranges logistical support as necessary.
• Receives and distributes mail, email communications, and legal documents.
• Review claims case file to determine if required forms and documents have been received; requests missing information from appropriate party; may prepare claims file, and if applicable according to specified criteria, prepares administrative decision for judges’ approval or prepares the file for presentation to judge for action.
• Maintains office supplies and assists in the general organization and operation of the adjudication office.
• Performs any related clerical and administrative duties as assigned by the Senior Judge.

Minimum Qualifications

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 this time, agencies may recruit and hire employees by making permanent non-competitive appointments and the official probationary period will begin.

At a future date (within one year of permanent appointment), 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 of 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.

Non-Competitive Minimum Qualifications:

Candidates must have:

Either

• Three years of full-time experience in a position where your primary responsibilities included extensive in-person or telephone customer service experience with the general public resolving customer's issues and/or problems; explaining programs/services, policies, or procedures; reconciling accounts; or experience examining, investigating, processing, or adjusting insurance claims; or responding to technical questions from policyholders or claimants;

Or

• An Associate degree may substitute for two years of specialized experience described in #1;

Or

• A bachelor's degree may substitute for four years of specialized experience described in #1

55 B/C QUALIFICATIONS:

Individuals certified eligible for the 55b/c program under the Governor’s Program to Hire Persons/Veterans with Disabilities pursuant to Section 55b/c of the Civil Service Law will also be considered. To be considered, you must meet the minimum qualifications and provide a copy of your letter of eligibility with your response.

Competitive Minimum Qualifications:

Civil Service List Appointment:

Candidates must be reachable on the appropriate Civil Service eligible list.

Transfer Qualifications:

Candidates must have one year permanent or 55 b/c service in a title designated as appropriate for transfer in accordance with 70.1 of the Civil Service Law.