STATE CLASSIFICATION JOB DESCRIPTION


Salary Group B16

Class No. 2922

CLAIMS EXAMINER II

GENERAL DESCRIPTION

Performs moderately complex (journey-level) disability determination or workers’ compensation work.  Work involves reviewing and evaluating claims for benefits.  May train others.  Works under general supervision, with moderate 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.

Maintains confidential files.

Participates in the development of a disability determination program or a workers’ compensation program.

Identifies and reports cases involving potential fraud.

Assists with developing physical or mental developmental assessments.

May order consultative examinations to investigate undocumented claims and/or clarify medical evidence.

May train others.

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, to communicate effectively, and to train others.


State Auditor’s Office

Revised 9-1-15