WORKERS' COMPENSATION BENEFITS EXAMINER 1B

Under direct supervision, receives and processes incoming workers’ compensation claims. Performs tasks such as the following: Reviews accident reports and other documents related to incoming claims to determine workers’ compensation coverage. Sets up computer files, enters information into computer, and updates computer records. Contacts City agency staff to make inquiries regarding claims; returns incomplete claims to appropriate party for additional information. Gathers information from cases files or computer records and prepares written material and forms for distribution. Responds to telephone inquiries from claimants and their attorneys and physicians. Schedules independent medical examinations to determine entitlement to workers’ compensation benefits. Makes inquiries about medical background of claimants. Reviews pending cases for possible third party coverage. Prepares recommendations for compensation. Processes payment for medical treatment. Computes benefit payments accruing to prospective recipients, their beneficiaries or medical providers and benefits and payment calculations involving workers’ compensation awards and medical bills. Investigates difficult cases and claimant’s alleged accident(s) and disability(ies) by contacting witnesses, city agencies, physicians, and other pertinent parties. Reviews cases upon return from hearings:
(a) to make payments or corrections of any awards and fees or decisions from the State Workers’ Compensation Board;
(b) to authorize the Comptroller to issue payments;
(c) to determine the need for scheduling independent medical examinations, witness and doctor’s testimony;
(d) to request that appropriate parties conduct investigations/surveillance, as required;
(e) to authorize treatments;
(f) to follow up on directives issued by legal and management staff. Examines and processes claims and bills submitted by medical practitioners and hospitals for payment or objection. Authorizes the Comptroller to issue payment of proper fee based upon the New York State Workers’ Compensation Board medical bill fee schedule. Reviews medical reports submitted by claimants, doctors and City doctors to determine continuing eligibility for benefits. Reviews cases and determines the need for and type of medical consultation appropriate to the circumstances of the cases. Reviews claims for processing voluntary awards of workers’ compensation benefits.

New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County. To determine if the residency requirement applies to you, please discuss with the agency representative at the time of interview.

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1. An associate degree or completion of 60 semester credits from an accredited college or university, including or supplemented by 6 semester credits in mathematics, statistics, accounting, and/or actuarial science; or

2. A four-year high school diploma or its educational equivalent and one year of satisfactory full-time experience implementing the provisions of a workers’ compensation or retirement or medical benefits plan, involving the use of mathematical, statistical, actuarial, or accounting computations; or

3. A combination of education and/or experience equivalent to “1" or “2" above. Satisfactory completion of 30 semester credits from an accredited college, including 3 semester credits in mathematics, statistics, accounting and/or actuarial science may be substituted for 6 months of the full-time experience as described in “2" above. However, all candidates must possess at least a four-year high school diploma or its educational equivalent.

SPECIAL NOTE:
A. Upon completion of one year of satisfactory continuous service in Assignment Level Ia, employees shall be assigned to Assignment Level Ib.
B. To be eligible for placement in Assignment Level Ib or II, individuals must have, in addition to meeting the minimum requirements, either:
1. One additional year of satisfactory full-time experience implementing the provisions of a workers' compensation or retirement or medical benefits plan involving the use of mathematical, statistical, actuarial, or accounting computations; or
2. A baccalaureate degree from an accredited college including or supplemented by 6 semester credits in mathematics, statistics, accounting and/or actuarial science.

SPECIAL NOTE:
C. To be eligible for placement in Assignment Level III, individuals must have, in addition to meeting the minimum requirements, either:
1. Two additional years of full-time experience as described in "Note B. 1" above; or
2. A baccalaureate degree from an accredited college including or supplemented by 6 semester credits in mathematics, statistics, accounting and/or actuarial science and one additional year of satisfactory full-time experience as described in "Note B. 1" above.

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.