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Workers' Compensation Claims Examiner

Expired Job

Office Of Workers' Compensation Programs San Francisco , CA 94102

Posted 2 months ago

Duties

Summary

This position is located in Department of Labor, Office of Workers' Compensation Programs (OWCP), Division of Federal Employees' Compensation (DFEC). DFEC adjudicates new claims for benefits and manages ongoing cases; pays medical expenses and compensation benefits to injured workers and survivors; and helps injured employees return to work when they are medically able
to do so.

Responsibilities

Workers Compensation Claims Examiners are responsible for adjudicating a broad range of disability and death claims. The difference in grade level is the complexity of cases and the amount of supervision.
Responsible for the development and adjudication of traumatic injury, occupational disease, and death claims filed by Federal civilian employees and their survivors under the Federal Employees Compensation Act, (FECA). New, incoming claims are examined for factual and medical sufficiency, giving consideration to the five basic requirements of entitlement: time, employee status, fact of injury, performance of duty, and causal relationship.
Responsible for determining entitlement to monetary compensation claims, developing pay rate information, calculating pay rates, and making accurate payments for short and long term disability claims as well as permanent impairment awards. Minimize over-payments and takes corrective actions to correct improper payments.
Respond to medical authorization requests by approving the request or developing the request for additional information.
Responsible for disability management through timely and appropriate interventions based on case specific circumstances.
Compose development letters, formal decisions with appeal rights, and general correspondence in response to inquiries from injured workers, employing agencies, attorneys, and medical providers.
Respond to telephonic inquiries in response to inquiries from stakeholders, including injured workers, employing agencies, attorneys, medical providers, and congressional offices.
Utilizes program-specific software to review imaged cases, to accurately update the database, to process payments, document phone calls, and generate correspondence. Other computer software utilized includes Microsoft Outlook and Microsoft Word in addition to various web sites.

Travel Required

Not required

Supervisory status

No

Promotion Potential

12

  • There is no obligation to provide future promotions to you if you are selected. Future promotions are dependent on your ability to perform the duties at a higher level, the continuing need for an employee assigned to the higher level, and supervisor.

Job family (Series)

Requirements

Conditions of Employment

U.S. Citizenship.
Appointment to this position may require a background investigation.
Requires a probationary period if the requirement has not been met.

Applicants must meet all legal and regulatory requirements. Reference the "Required Documents" section for additional requirements.

Qualifications

Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level in the Federal Service or meet the education requirement or have an equivalent combination of education and experience.
For the GS-9 level, Applicants must possess 52 weeks of specialized experience equivalent to the GS-7 in the Federal Service.
Specialized experience is experience examining and assisting in adjudicating and/or making/recommending determinations on claims for compensation; evaluating pertinent medical facts; applying and interpreting laws, regulations, policies, precedents and other criteria on claims;
OR
Master's or equivalent graduate degree;
OR
two (2) full years of progressively higher level graduate education leading to such a degree;
OR
LL.B. or J.D., if related.
For the GS-11 level, Applicants must possess 52 weeks of specialized experience equivalent to the GS-9 in the Federal Service.
Specialized experience is experience adjudicating and processing claims for compensation to include investigating medical and other benefits, and issuance of recommendations or decisions to award or deny those benefits;
OR
Ph.D. or equivalent doctoral degree;
OR
three (3) full years of progressively higher level graduate education leading to such a degree;
OR
LL.M., if related.
For the GS-12 level, Applicants must possess 52 weeks of specialized experience equivalent to the GS-11 in the Federal Service.
Specialized experience is experience gained in evaluating medical documentation, medical reports, and other evidentiary documents submitted with or subsequent to the initial claims, verifies claims involve in employment-related occupational illnesses.
There is no substitution of education for experience at the GS-12 level.

Education

College Transcript and Evaluation of Foreign Education

  • The Department of Labor does not recognize academic degrees from unauthorized secondary schools or post-secondary institutions that are not accredited by an accrediting body recognized by the Department of 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 course work requirements for this position. Click for more information.

Additional information

DOL seeks to attract and retain a high performing and diverse workforce in which employees differences are respected and valued to better meet the varying needs of the diverse customers we serve. DOL fosters a diverse and inclusive work environment that promotes collaboration, flexibility and fairness so that all individuals are able to participate and contribute to their full potential.
Additional positions may be filled from this announcement if more vacancies become available.

Refer to these links for more information:,,

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

If you meet the minimum qualifications, you will be evaluated against the evaluation factors below and will be placed into a category based on your vacancy question responses.

Categories

Category A

  • Meets the basic qualification requirements for the vacancy and has successful experience in the same or similar job that has demonstrated superior proficiency in applying critical competencies required by this position to work of increased levels of difficulty and complexity.
    Category B

  • Meets the basic qualification requirements for the vacancy and demonstrates satisfactory proficiency in the critical competencies required by this position.
    Category C

  • Meets the specialized experience described in the minimum qualifications requirements section of this announcement and demonstrates proficiency in the basic competencies.
    Evaluation Factors (Competencies) - All qualified applicants will be evaluated on the following key competencies:
    Legal, Government and Jurisprudence

  • Knowledge and application of laws, regulations, court procedures, precedents, legal practices and documents, government regulations, executive orders, agency rules, government organization and functions.
    Customer Service

  • Works with clients and customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.
    Written Communication

  • Recognizes or uses correct English grammar, punctuation, and spelling; communicates information (for example, fact, ideas, or messages) in a succinct and organized manner; produces written information, which may include technical material that is appropriate for the intended audience.
    Flexibility

  • Is open to change and new information; adapts behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deals with ambiguity.
    Decision Making

  • Makes sound, well-informed, and objective decisions; perceives the impact and implications of decisions; commits to action, even in uncertain situations, to accomplish organizational goals; causes change.
    Self-Management

  • Sets well-defined and realistic personal goals; displays a high level of initiative, effort, and commitment towards completing assignments in a timely manner; works with minimal supervision; is motivated to achieve; demonstrates responsible behavior.
    The information you provide may be verified by a review of your work experience and/or education, by checking references and through other means (ex. interview). The examining Human Resources Office (HRO) makes final determination concerning applicant ratings. Your resume MUST provide sufficient information to substantiate your responses to the vacancy questions. If not, the HRO may amend your responses to more accurately reflect the level of competency indicated by the content of your resume. Your evaluation may also include a review by a Human Resources Specialist or panel and may include other assessments (ex. interview, panel review, written test, writing sample, etc.)

INFORMATION FOR ICTAP/CTAP ELIGIBLES ONLY: If you are eligible for special priority selection under ICTAP/CTAP, you must be well-qualified for the position to receive consideration. ICTAP/CTAP eligibles who are placed into Category B or higher will be considered "well-qualified".

Click for more information.
To preview questions please .

Background checks and security clearance

Security clearance

Drug test required

No

Required Documents

The following documents must be submitted by 11:59 p.m. (ET) on the vacancy closing date. Follow the instructions: click . You are not required to submit a document if it does not apply to you.

Warning: If you submit a document using the same document title, the 2nd submission will OVERWRITE the 1st submission. Also, do not upload password protected documents.

  • Veterans Documents (if applicable): To be considered as a 5-point preference eligible, you must submit a copy of your Certificate of Release or Discharge From Active Duty, DD214. Your DD-214 must show the type of discharge and dates of active duty.

    To claim 10-point preference, you must submit a copy of your DD214; an Application for 10-point Veteran's Preference, SF15; and the proof of entitlement of this preference which is normally an official statement, dated 1991 or later, from the Department of Veterans Affairs certifying to the present existence of the service-connected disability and indicating the percentage of your disability. (For active duty service members expecting honorable or general discharge or release within 120 days, click ). Without this documentation, you will not receive veteran's preference. For more information, go to:

  • Displaced Employee Placement Documents Only required if requesting priority consideration under eligibility.

  • Cover Letters are not mandatory and will not be used to verify experience, but may be submitted

Applicants selected for employment who are not current DOL employees will be required to provide, and the system will be used to confirm the employment eligibility of all new hires.

If you are relying on your education to meet qualification requirements:

Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from .
Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

This job originated on . For the full announcement and to apply, visit . Only resumes submitted according to the instructions on the job announcement listed at will be considered.



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Workers' Compensation Claims Examiner

Expired Job

Office Of Workers' Compensation Programs