Workers' Compensation Claims Examiner

Summary

This position is located in the Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), Division of Energy Employees' Occupational Illness Compensation (DEEOIC). The mission of DEEOIC is to administer the benefits; provision of the Energy Employees Occupational Illness Compensation Program Act.

Duties

Duties include but are not limited to the following: - Gather, identify, and analyze clear-cut medical evidence with or subsequent to the initial home health care claim or authorization request and provides information to senior team members to develop appropriate actions. - Contact stakeholders (e.g., claimants, representatives, medical officials, etc.) to obtain corrected or supplementation documentation to support the claim/request (e.g., home health care, durable medical equipment, travel, etc.) and to resolve conventional issues. - Assist senior examiners or team leader in the development of questions for physicians in cases that involve the need for supplemental medical information, resolution of conflicting medical documentation, or medical authorization requests. - Conduct fact-finding for routine and less complex cases to review clear-cut evidence submitted in support of an initial home health care claim or other medical authorization requests. - Apply knowledge of DEEOIC laws, regulations, and policies to assigned claims selected for training and developmental purposes.

Qualifications

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Position titles alone cannot be used to determine if you are qualified. Please list dates in MM/DD/YY format. This is imperative in determining if whether you have at least one year of creditable specialized experience. Dates will not be assumed. Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level. Qualifying specialized experience for GS-7 includes: 3 out of 4 from the below: - Using basic medical terminology associated with illnesses and prescribed treatment. - Receiving and evaluating claims forms, reports, and supporting documents for accuracy and completion. - Applying knowledge of multi-disciplinary medical treatment programs and associated costs. - Communicating and writing routine correspondence to elicit or convey information to diverse audiences. or Education: 1 full year of graduate level education (One year of full-time graduate education is considered to be the number of credit hours that the school attended has determined to represent 1 year of full-time study. If that information cannot be obtained from the school, 18 semester hours should be considered as satisfying the 1 year of full-time study requirement). or superior academic achievement (General Schedule Qualification Policies) or Combination of Education and Experience: A combination of education and experience may be used to qualify for this position as long as the computed percentage of the requirements is at least 100%. To compute the percentage of the requirements, divide your total months of experience by 12. Then divide the total number of completed graduate semester hours (or equivalent) by 18. Add the two percentages.

Education

Any applicant falsely claiming an academic degree from an accredited school will be subject to actions ranging from disqualification from federal employment to removal from federal service. If your education was completed at a foreign college or university, you must show comparability to education received in accredited educational institutions in the United States and comparability to applicable minimum coursework requirements for this position. Click Evaluation of Foreign Education for more information.