STATE CLASSIFICATION JOB DESCRIPTION


Salary Group B14

Class No. 2921

CLAIMS EXAMINER I

GENERAL DESCRIPTION

Performs routine (journey-level) disability determination or workers’ compensation work.  Work involves reviewing and evaluating claims for benefits.  Works under moderate supervision, with limited latitude for the use of initiative and independent judgment.

EXAMPLES OF WORK PERFORMED

Researches and reviews disability or workers’ compensation claims to determine jurisdiction and to secure proper documentation.

Reviews and evaluates injury and accident records and reports.

Requests consultative examinations to develop sufficient evidence to settle claims and obtains medical or vocational reviews of evidence.

Settles disability or workers’ compensation claims and prepares documented determinations regarding whether a disability or work-related injury exists.

Prepares forms, letters, and supporting materials to complete claimant profiles and document disability or workers’ compensation decisions.

Provides technical consultations.

Assists with maintaining confidential files.

Assists with developing physical or mental developmental assessments.

Assists in identifying and reporting cases involving potential fraud.

May participate in special projects related to the development of a disability determination program or a workers’ compensation program.

Performs related work as assigned.

GENERAL QUALIFICATION GUIDELINES

Experience and Education

Experience in disability determination, workers’ compensation, or insurance.  Graduation from an accredited four-year college or university with major coursework in business, social work, or a related field is generally preferred.  Experience and education may be substituted for one another.

Knowledge, Skills, and Abilities

Knowledge of applicable laws and regulations concerning disability determination or workers’ compensation, and of medical and psychological terminology.

Skill in customer service techniques, and in the use of a computer and office equipment.

Ability to prepare determinations or claims explanations, to apply and explain relevant laws, to read and analyze documents, to prepare correspondence and reports, to manage caseloads, and to communicate effectively.


State Auditor’s Office

Revised 9-1-15