Workers' Compensation Claims Examiner

Summary

This position is located in the Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), Division of Energy Employees' Occupational Illness Compensation (DEEOIC). The mission of DEEOIC is to administer the benefits; provision of the Energy Employees Occupational Illness Compensation Program Act.

Duties

Duties include but are not limited to the following: - Gather, identify, and analyze clear-cut medical evidence with or subsequent to the initial home health care claim or authorization request and provides information to senior team members to develop appropriate actions.- Contact stakeholders (e.g., claimants, representatives, medical officials, etc.) to obtain corrected or supplementation documentation to support the claim/request (e.g., home health care, durable medical equipment, travel, etc.) and to resolve conventional issues.- Assist senior examiners or team leader in the development of questions for physicians in cases that involve the need for supplemental medical information, resolution of conflicting medical documentation, or medical authorization requests.- Conduct fact-finding for routine and less complex cases to review clear-cut evidence submitted in support of an initial home health care claim or other medical authorization requests.- Apply knowledge of DEEOIC laws, regulations, and policies to assigned claims selected for training and developmental purposes. Qualifications

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Position titles alone cannot be used to determine if you are qualified. Please list dates in MM/DD/YY format. This is imperative in determining if whether you have at least one year of creditable specialized experience. Dates will not be assumed. GS 7 Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-5 in the Federal Service. Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level. Qualifying specialized experience for GS-7 includes:3 out of 4 from the below: - Using basic medical terminology associated with illnesses and prescribed treatment. - Receiving and evaluating claims forms, reports, and supporting documents for accuracy and completion. - Applying knowledge of multi-disciplinary medical treatment programs and associated costs. - Communicating and writing routine correspondence to elicit or convey information to diverse audiences. or Education: 1 full year of graduate level education (One year of full-time graduate education is considered to be the number of credit hours that the school attended has determined to represent 1 year of full-time study. If that information cannot be obtained from the school, 18 semester hours should be considered as satisfying the 1 year of full-time study requirement). or superior academic achievement (General Schedule Qualification Policies) or Combination of Education and Experience: A combination of education and experience may be used to qualify for this position as long as the computed percentage of the requirements is at least 100%. To compute the percentage of the requirements, divide your total months of experience by 12. Then divide the total number of completed graduate semester hours (or equivalent) by 18. Add the two percentages.

Education

Any applicant falsely claiming an academic degree from an accredited school will be subject to actions ranging from disqualification from federal employment to removal from federal service. If your education was completed at a foreign college or university, you must show comparability to education received in accredited educational institutions in the United States and comparability to applicable minimum coursework requirements for this position. Click Evaluation of Foreign Education for more information. How You Will Be Evaluated

Your evaluation will be based on how well you meet the qualifications outlined in this vacancy announcement, as demonstrated through your resume and supporting documentation. You may preview application questions for this vacancy here: https://apply.usastaffing.gov/ViewQuestionnaire/13067509 USA Hire You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics): Attention to Detail Customer Service Flexibility Integrity/Honesty Interpersonal Skills Reading Comprehension Teamwork The information you provide may be verified by a review of your paid, unpaid, and volunteer, as it demonstrates the competencies or skills required for the position to be filled. Your evaluation may include an interview, reference checks, or other assessment conducted by HR specialists, subject matter experts, or panel members and may include other assessment tools (ex. interview, structured interview, written test, work sample, etc.). INFORMATION FOR ICTAP/CTAP ELIGIBLE(S) ONLY: If you are eligible for special priority selection under ICTAP/CTAP, you must be well-qualified for the position to receive consideration. ICTAP/CTAP eligible(s) will be considered well-qualified if they attain at least a rating score of 85 in a numerical rating scheme. Be sure to review the eligibility questions to reflect that you are applying as an ICTAP or CTAP eligible and submit supporting documentation. As a condition of employment for accepting this position, you may be required to serve a 1-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider: - your performance and conduct; - the needs and interests of the agency; - whether your continued employment would advance organizational goals of the agency or the Government; and - whether your continued employment would advance the efficiency of the Federal service. Upon completion of your probationary period your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest. NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date. For more detailed information on applying for positions with DOL click here to view the U.S. Department of Labor, How to Apply website. Other Information

The mission of the Department of Labor (DOL) is to protect the welfare of workers and job seekers, improve working conditions, expand high-quality employment opportunities, and assure work-related benefits and rights for all workers. Refer to these links for more information: GENERAL INFORMATION, REASONABLE ACCOMMODATIONS, ADDITIONAL DOCUMENTATION, FORMER FEDERAL EMPLOYEES As a condition of employment, all personnel must undergo a background investigation for access to DOL facilities, systems, information and/or classified materials before they can enter on duty: BACKGROUND INVESTIGATION This position is inside the bargaining unit. If the duty location is within the Washington, D.C. metropolitan area, the position will be included in the Local 12, AFGE bargaining unit. If the duty location is outside the Washington, D.C. metropolitan area, the position will be included in the NCFLL bargaining unit. For more information, Click here for Career Ladder Promotion Information For more information, click Telework Position Information. This is not a remote work position. The selectee will report to an assigned DOL office location on a regular basis and is eligible for participation in telework as determined by management in accordance with DOL policy. Based on agency needs, additional positions may be filled using this vacancy. The Department of Labor may use certain incentives and hiring flexibilities, currently offered by the Federal government to attract highly qualified candidates. Click here for Additional Information. The Fair Chance Act (FCA) prohibits Federal agencies from requesting an applicant's criminal history information before the agency makes a conditional offer of employment. If you believe a DOL employee has violated your rights under the FCA, you may file a complaint of the alleged violation following our agency's complaint process Guidelines for Reporting Violations of the Fair Chance Act. Note: The FCA does not apply to some positions specified under the Act, such as law enforcement or national security positions. All Department of Labor employees are subject to the provisions of the Drug-Free Workplace Program under Executive Order 12564 and Public Law 100-71. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments.