CLAIMS EXAMINER WORKMENS COMPENSATION

Code: 01241 Local Competitive

Official job specification

The text below is the official specification published by the New Jersey Civil Service Commission. The plain-language summary and analysis above are derived from it by NJ Civil Service Navigator. Source: the official specification page at NJ CSC.

Definition

Under direction, receives accident reports for all municipal employees and makes tentative determinations as to eligibility for Workers Compensation in accord with the statutes of the State of New Jersey governing Workers Compensation and municipal regulations concerning local employees; reviews, checks, and certifies reports and applications; prepares and maintains records and files; does other related duties as required.

Examples of work

• Receives and processes all accident reports for all municipal employees.
• Reviews, checks, and certifies reports, applications, and other documents for correctness.
• Interviews and transacts routine business with persons who may call at the office.
• Compiles statistical and other data.
• Reviews and adjusts complaints.
• Prepares and verifies bills.
• Handles routine correspondence.
• Approves for payment and processes medical bills and any additional claims relating to Workers Compensation claims.
• Verifies accuracy of all bills and medical reports before clearance for payment.
• Contacts doctors, hospitals, and companies to whom payment is due to check the status of bills, advise them of errors, and request corrected bills.
• Posts invoice of payments and gathers all data pertinent to compensation claims.
• Refers claimants to various municipal doctors for examination.
• Establishes and maintains a ledger of all court compensation cases with complete cost to the municipality.
• Gathers data for compensation cases.
• Enters documents from various forms of copy into computer systems
• Will be required to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.

Experience

Two(2) years of experience in work involving conducting interviews, computing figures, and verifying claims.

License

Appointees will be required to possess a driver's license valid in New Jersey only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position.

Knowledge, skills and abilities

• Knowledge of methods used to conduct interviews.
• Knowledge of basic mathematic principles.
• Knowledge of methods used to verify information
• Knowledge of Statutes of the State of New Jersey governing Workers Compensation and municipal regulations concerning local employees after a period of training.
• Knowledge of office methods, practices, and equipment.
• Ability to organize and develop efficient work methods.
• Ability to maintain essential records and files.
• Ability to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units.
• Ability to read, write, speak, understand, or communicate in English sufficiently to perform the duties of this position. American Sign Language or Braille may also be considered as acceptable forms of communication.
• Persons with mental or physical disabilities are eligible as long as they can perform the essential functions of the job after reasonable accommodation is made to their known limitations. If the accommodation cannot be made because it would cause the employer undue hardship, such persons may not be eligible.

Note

The definition and examples of work for this title are for illustrative purposes only. A particular position using this title may not perform all duties listed in this job specification. Conversely, all duties performed on the job may not be listed.