Workers' Compensation Claims Examiner

Summary This position is located in the Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), and can be assigned to a Workers' Compensation Claims Examiner in any of the four programs. The Division of Federal Employees' Compensation (DFEC), the Division of Longshore and Harbor Workers Compensation (DLHWC), the Division of Coal Mine Workers' Compensation (DCMWC) or the Division of Energy Employees Occupational Illness Compensation (DEEOIC). Responsibilities -Properly examine medical and other factual evidence for claims for benefits involving work-place injuries and/or illnesses for factual sufficiency and legal correctness to determine if the compensation claim and/or medical benefit claim meets the criteria outlined in established policies, procedures, or other guidelines. -Prepare correspondence and maintain working relationships with claimants, witnesses, employers, physicians, medical providers, investigators, representatives, attorneys, and other sources to obtain missing or supplemental medical and employment documents, to clarify information, and to secure additional factual and medical information needed to adjudicate the claim. -Provide technical assistance and advice to claimants and/or their representatives on eligibility for benefits. -Review and evaluate a variety of evidentiary documents (e.g., narrative medical reports commenting upon the relationships of the disability to the implicated employment factors, history of claimant's disability and health history, specifics of employment felt to be the cause of injury, job descriptions, workplace exposures, comments on the veracity of the claimant's statements, employment records, letters or certificates of medical necessity , etc.) from a variety of sources submitted with or subsequent to the initial claim. -Familiar with the appropriate program statute, regulations, and policies so that they can perform specialized adjudicatory functions required by the appropriate program's procedure manual to determine the amount of compensation to be paid, the duration of periodic compensation, and/or reimbursement for medical or other expenses. -Respond in writing and/or via telephone, as appropriate, to received written correspondence, telephone messages, or inquiries via automated system. -Apply knowledge of workers' compensation laws, regulations, and policies to develop and make determinations on the proper disposition of claims for assigned cases. -Maintain and update claim data within appropriate applications (e.g., claims database, bill pay applications, or parallel applications) to reflect the status and level of entitlement. Requirements Conditions of Employment 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. 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: 1. Receiving and evaluating forms, reports, and supporting documents for accuracy and completeness. 2. Using basic medical terminology associated with illnesses and injury. 3. Communicating with customers to elicit or convey technical information. 4. Writing correspondence of a business nature seeking information, recommendations or decisions. 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. Additional Information Applicants must meet all legal and regulatory requirements. Reference the Required Documents section for additional requirements. 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 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 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. 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.