State Workers' Insurance Fund Claims Adjuster

Are you an analytically minded individual that enjoys solving complex projects involving insurance claims and litigation? If so, considering joining the State Workers' Insurance Fund (SWIF) as a Claims Adjuster. This position gives you the opportunity to showcase your specialized skillset as you investigate, process, and manage reported work-related claims and injuries for employees of policy holders covered by our organization to determine compensability. Take pride in knowing your work is helping Pennsylvanian's in need, apply today!

As a Claims Adjuster, you will be tasked with completing investigations for reported incidents and claims, processing acceptance or denial within an established timeframe. Work involves determining if pre-existing conditions may impact a claim; identifying potential fraud; and making recommendations if excess use of physical therapy or medical equipment is identified. Effective communication is essential as you will have the opportunity to correspond with with claimants, employers, doctors, hospitals, and witnesses to determine eligibility for workers' compensation benefits. You will also be responsible for monitoring claims, creating fact-based claims, and accurately completing all required forms. Additional responsibilities include:

• Recommending use of Independent Medical Examinations (IME)
• Issuing ongoing indemnity payments
• Determining liability on all medical bills
• Processing claim payment related vouchers

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

Work Schedule and Additional Information:

• Full-time employment
• Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.
• Telework: You may have the opportunity to work from home (telework) part-time. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Erie.
• Salary: In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

QUALIFICATIONS

Minimum Experience and Training Requirements:

• One year of experience as a SWIF Claims Representative (commonwealth title or equivalent Federal Government job title, as determined by the Office of Administration); or
• One year of technical work in the processing, review, investigation, and payment of workers' compensation insurance claims in the insurance industry; or
• An equivalent combination of experience and training.

Additional Requirements:

• You must demonstrate the ability to adhere to the values and ethics of the Department of Labor & Industry.
• You must demonstrate the ability to work with professionalism, discretion, and good work ethic.
• You must possess solid written and verbal communication skills.
• You must demonstrate initiative and problem-solving skills.
• You must be able to perform essential job functions.
• You must be able to perform essential job functions.

Commonwealth employees who wish to use their seniority rights must apply to the internal posting for their seniority rights to be considered.

How to Apply:

• Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
• If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
• Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
• Failure to comply with the above application requirements may eliminate you from consideration for this position.

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.