Description:
Duties Description
- Maintain caseloads and assignments for specified policyholders and employers providing various services throughout a life cycle.
- Review all work products for accuracy and completeness and determine whether additional information is required.
- Accurately process caseloads and work in designated systems, efficiently enough to maintain and meet required deadlines which prevent the agency from incurring penalties.
- Work with policyholders to qualify and quantify an employee/claimant.
- Communicate with claimants, policyholders, medical providers, and various entities to gather information needed to process assigned work.
- Examine accident and medical reports to determine compensability and liability, seeking guidance and expertise as needed if complex medical issues arise, and initiate proactive follow ups for all updated information as needed.
- Conduct research to cross-check current, existing, or past payments being provided to check the coordination of claims, if applicable.
- Provide any additional information required to assist various internal agency Departments in reviewing unique and/or complex scenarios and work with the
Departments to implement the recommendations.
- Acquire an understanding of the NYS Workers’ Compensation Law, Disability Benefits Law and/or the Paid Family Leave Benefits Law, and all other applicable New York State laws, rules and regulations related to programmatic operations.
- Establish a comprehensive knowledge of the resources available to resolve issues and answer questions about assignments.
- Keep complete records and internal controls utilizing a variety of internal systems.
- Provide customer service to all claimants, policyholders, medical providers and brokers, and internal agency staff, responding in a timely manner to all inquiries from any source including telephone, email, letter, and web inquiry.
- Assist with other claims functions including answering provider calls, processing bill corrections, and assisting with CMS correspondence as assigned.
- Work with agency staff on special projects as directed.
Qualifications Minimum Qualifications
- One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of Civil Service Law. Eligible titles include, but are not limited to: Administrative Assistant 1, Business Document Specialist 2, Motor Vehicle Consumer Services Representative 1, Licensing Examiner 1, Taxpayer Services Representative 1, Program Aide, Payroll Examiner 1; OR
- Four years of customer service experience that required independence in both verbal and written communication responsibilities; OR
- An associate degree or higher and two years of customer service experience that required independence in both verbal and written communication responsibilities.