STATE CLASSIFICATION JOB DESCRIPTION


Salary Group B19

Class No. 3670

BENEFIT REVIEW OFFICER I

GENERAL DESCRIPTION

Performs complex (journey-level) claims and benefits dispute mediation work. Work involves assisting in prehearing and benefit review conferences involving disputed claims and benefits, hearing presentations submitted by injured workers and private and government insurance carriers, making recommendations on resolutions, mediating disputes, and preparing reports on recommendations. Works under general supervision, with moderate latitude for the use of initiative and independent judgment.

EXAMPLES OF WORK PERFORMED

Directs questions to involved parties to supplement or clarify information in the claim file.

Attends presentations provided by injured workers and private and government insurance carriers.

Informs involved parties of rights and responsibilities in accordance with agency policies and state statutes.

Prepares employee wage records, medical records, and other pertinent information for the proper determination of benefits.

Assists in prehearing and benefit review conferences for disputed claims.

Assists in mediating disputes between claimants and insurance companies and assists with the adjustment of the claims consistent with policies and statutes.

Assists in coordinating benefit review dockets in accordance with docket scheduling procedures.

Assists in scheduling benefit review conferences.

Assists in preparing written reports detailing issues that are not resolved during a benefit review conference.

Assists in preparing written reports on recommendations and unresolved issues; and prepares and approves agreements or settlements.

Performs related work as assigned.

GENERAL QUALIFICATION GUIDELINES

Experience and Education

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

Knowledge, Skills, and Abilities

Knowledge of the relevant federal and state rules and regulations relative to specific area of claims.

Skill in conducting dispute resolutions, mediations, and benefit review conferences; in preparing settlements and agreements; and in using computers and applicable software.

Ability to analyze medical evidence and determine income benefits, and to communicate effectively.


State Auditor’s Office

Added 9-1-17