State Workers' Insurance Fund Claims Representative

THE POSITION

Are you ready to take the next step in your career? If so, consider joining the Department of Labor & Industry, State Workers' Insurance Fund (SWIF) as a Claims Representative. This position gives you the opportunity to investigate, process, and manage reported work-related claims or injuries for employees of policy holders covered by the State Workers' Insurance Fund for the purpose of determining compensability. If you are an analytically minded professional with a keen eye for detail, we need you on our team!

DESCRIPTION OF WORK

As a Claims Representative, your focus will be on completing investigations for reported work related or injury incidents or claims; processing acceptance or denial within 48 hours of receiving the assignment. The investigation must include consideration of the course and scope, employment relationship and may include, but should not be limited to vehicle accident, coming and going, if appropriate to the assigned office, firefighter affiliation, undocumented worker, misclassification, and all other information that is necessary to determine compensability of the present claim. You will have the opportunity to monitor and control all aspects of the claim to conclusion in accordance with established authority and procedure. You can expect to handle all aspects of minor disability or lost time claims with closed periods of disability or anticipated lost time of less than eight weeks.

Additional duties to include but not limited to :

• Making determinations to identify potential fraud, documenting and reporting all suspected fraud to the SWIF fraud investigator and supervisor
• Identifying and making recommendations to supervisor when identified excess use of Physical Therapy or Durable Medical Equipment supplies have been ongoing for an extended or excessive period of time
• Ensuring claim intake data is complete and accurate including but not limited to claimant data, employer data, NAICS and incident information
• Contacting appropriate parties related to the reported claim including claimant, employers, doctors, hospitals, and witnesses to determine eligibility for workers' compensation benefits

Interested in learning more? Additional details regarding this position can be found in the position description .

Work Schedule and Additional Information :

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY

QUALIFICATIONS

Minimum Experience and Training Requirements :

Additional Requirements :

How to Apply :

Veterans :

Telecommunications Relay Service (TRS) :

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.