STATE CLASSIFICATION JOB DESCRIPTION


Salary Group B21

Class No. 3672

BENEFIT REVIEW OFFICER II

GENERAL DESCRIPTION

Performs advanced (senior-level) claims and benefits dispute mediation work. Work involves conducting 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.  May supervise the work of others.  Works under limited supervision, with considerable latitude for the use of initiative and independent judgment.

EXAMPLES OF WORK PERFORMED

Conducts prehearing and benefit review conferences for disputed claims.

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 and makes recommendations for resolution.

Mediates disputes between claimants and insurance companies and adjusts claims consistent with policies and statutes.

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

Coordinates benefit review dockets in accordance with docket scheduling procedures.

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

Schedules additional benefit review conferences, as needed, if additional information was not produced at an initial conference.

Prepares written reports detailing issues that are not resolved during a benefit review conference.

Prepares written reports on recommendations and unresolved issues; and prepares and approves agreements or settlements.

Prepares and conducts training sessions.

May supervise the work of others.

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 conduct training sessions, to analyze medical evidence and determine income benefits, to mediate disputes, to communicate effectively, and to supervise the work of others.


State Auditor’s Office

Revised 9-1-17