Minimum Qualifications:For Appointment to Claims Services Representative 1, SG-18:• Reachable on current Civil Service eligible list for this title; OR• One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Administrative Specialist 1, Investigator 2 (Compensation Claims), Policyholder Services Representative 1, Underwriter 1, Underwriter 1 (Disability Benefits); OR• A bachelor’s or higher degree AND two years of New York State workers’ compensation claims adjustor experience; OR• A juris doctor, master’s or higher degree in a field related to the position being filled AND one year of New York State workers’ compensation claims adjustor experience.For Appointment to Claims Services Representative Trainee 1:• Reachable on current Civil Service eligible list for this title; OR• One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Investigator 1,Assistant Insurance Fund Services Representative, Program Aide; OR• A bachelor's or higher degree (in any area of study).Candidates who are active on the most recent Professional Career Opportunities examination list are encouraged to apply.Please be advised that the New York State Insurance Fund does not offer sponsorship for employment visas to employees or potential employees. Candidates sponsored for employment by an organization should be aware of their sponsorship status and the relevant expiration date(s) of that sponsorship before applying to this position.Duties Description:Under the general supervision of a Claims Services Representative 2, the incumbent will oversee all aspects of workers' compensation claims processing from inception to closing; initially determine the compensability of claims and file appropriate documentation with the Workers Compensation Board (WCB); calculate and adjust reserves consistent with case analysis over the anticipated life of the claim; recommend cases for appeal to WCB; negotiate and/or make recommendations regarding lump sum settlements; issue payments and requests for reimbursement where claims for supplemental benefits are involved; review awards to ensure the correct recipient and rate of compensation; schedule or waive medical examinations as necessary; analyze medical bills to determine causality, levels of treatment, necessity for treatment, appropriateness of fees and procedure codes, and apportionment status; respond to requests for home modifications, home health care personnel, medication, and medical supplies and appliances; and review case activity and determine when a claim can be retired.Specific duties to be discussed at time of interview.

Minimum Salary: 49363 Maximum Salary: 82656 Salary Unit: Yearly