StateJobsNY

NY HELPNo

AgencyWorkers' Compensation Board

TitleWorkers' Compensation Examiner, WCB Item #8194

Occupational CategoryNo Preference

Salary Grade14

Bargaining UnitASU - Administrative Services Unit (CSEA)

Salary RangeFrom $48728 to $59186 Annually

Employment Type Full-Time

Appointment Type Permanent

Jurisdictional Class Competitive Class

Travel Percentage 0%

Workweek Mon-Fri

Hours Per Week 37.5

Workday

From 8:30 AM

To 4:30 PM

Flextime allowed? No

Mandatory overtime? No

Compressed workweek allowed? No

Telecommuting allowed? No

County Schenectady

Street Address Operations and Programs/Disputed Medical Bills

328 State Street

City Schenectady

StateNY

Zip Code12305

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

OR

Candidates must have at least one year of permanent competitive service in a title designated as appropriate for transfer in accordance with Section 70.1 of the Civil Service Law. Candidates holding a permanent position of Workers’ Compensation Examiner may be eligible for reassignment or transfer.

Duties Description The position of WC Examiner would encompass but not be limited to the following duties:
• Review Form HP-1 [Health Provider’s Request for Decision on Unpaid Medical Bill(s)] to validate that it was submitted timely and contains all required information;
• Review Form HP-1 attachments to validate that all required documents are attached;
• Review request to validate that bills were submitted timely and to the proper carrier;
• Review request to validate that treatment is casually related to the sites/condition established for the claim;
• Review entire case folder to identify if medical treatment remains open or has been closed by Section 32;
• Review entire case folder to identify and related legal issues submitted on Form C-8.1 [Notice of Treatment Issue (s) Disputed Bill Issue (s)] or related value issues submitted on Form C-8.4 [Notice to Health Care Provider and Injured Worker of a Carrier’s Refusal to Pay All (or a Portion of) a Medical Bill Due to Valuation Objection(s)] and determine the status/resolution of those issues, including review of proposed decision by conciliation, proposed decision objection law judge’s decision, request for administrative or board review or board panel/full board decision;
• Apply knowledge of applicable WCB Law and Regulations and identified issues/resolutions to determine acceptance/rejection of request;
• Apply knowledge of applicable NYS Medical Fee Schedule payment or ground rule information to determine acceptance/rejection of request and calculate proper payment amount;
• Accept request when appropriate and accurately prepare Form HP-2 [Notice of Decision And Administrative Award];
• Reject request when appropriate and accurately prepare Letter of Rejection that indicates appropriate reason(s);
• Review Form HP-2 [Carrier Objection To Administrative Award} to validate that it was submitted timely and contains all required information;
• Review objection and, if necessary, entire case folder to validate information
• Apply knowledge of applicable WCB Law and Regulations to determine acceptance/rejection of objection
• Accept or reject objection when appropriate and accurately prepare Form HP-3
[Determination On Reconsideration Of Administrative Award-Rescinded] or HP-3.1
[Determination On Reconsideration Of Administrative Award-Upheld] that includes appropriate standard reasons or composes unique explanation with clear, concise and accurate wording;
• Draft response to written communications received via mail or electronic transmittal;
• Use the CIS/ECF system as needed for the review of Form HP-1 and HP-2 attachments;
• Use the HPA system as needed for the creation of Form HP-2, Letter of Rejection, Form HP-3 or Form HP-3.1.

Additional Comments *This position is being posted in anticipation of an approved DOB waiver.

Some positions may require additional credentials or a background check to verify your identity.

Name Recruitment Unit

Telephone 518-474-2685

Fax 518-486-6364

Email Address HRM@WCB.NY.GOV

Address

Street Human Resources Management

328 State Street

City Schenectady

State NY

Zip Code 12305

Notes on ApplyingQualified candidates should send a letter of interest and resume which lists your actual Civil Service title, salary grade and specific verifiable information as to how you meet the minimum qualifications to be eligible to apply for this position. Please send your application to HRM@WCB.ny.gov (email applications are preferred). It is important that you reference the WCB Item #8194 in the subject line of your email to ensure receipt of your application. (Please do not reference the Vacancy ID No.)