Workers' Compensation Claims Examiner

Office of Workers' Compensation Programs | Greensburg, PA

Posted Date 11/08/2019
Description

These positions are located in the Department of Labor, Office of Workers Compensation Programs (OWCP), Division of Coal Mine Workers' Compensation Programs (DCMWC) District Office in Greensburg, PA.

 

The mission of the office is to provide black lung benefits and medical treatment coverage to coal miners who have been totally disabled by chronic dust disease of the lungs arising out of employment in the Nation's coal mines, as well as to provide benefits to the survivors of coal miners who died from the disease. 

This position is inside the bargaining unit.

Selection(s) can be made at any advertised grade(s).

Additional selections may be made from this vacancy announcement.

PCS/Relocation funds are not available.

If selected for this position, you will receive on the job training in the duties performed as a Claims Examiner. The selectee adjudicates increasingly difficult claims as a continuation of their development for work at the next level. Claims are assigned to provide training in developing facts and evidence, to develop a lay medical knowledge of physical impairments, and to obtain knowledge in the application of workers' compensation statutes, regulations and precedents.

Duties performed fall into the following areas: Review, examination, development, and adjudication of disability and death claims arising under the Federal Coal Mine Health and Safety Act of 1969, as amended.; examine and develop reports of disability and death and obtains supporting documents; compile and collect all the information and evidence for the proper disposition of a claim; verifies benefit payments; reviews and processes contested cases.

Furnishing advice and assistance through interviews and correspondence; advices interested parties by telephone and in writing of the applicable provisions of the Act; secures and provides technical information of both medical and quasi legal character of the rights, duties and remedies of beneficiaries under the Act.

Reports writing and related research activities; assembles information for statements of fact and statements of issues in controversial cases involving a novel situation or establishment of precedent and policy and in cases where the issues were not resolved at the informal conference; prepares drafts of proposed questions for presentation to impartial specialist in various medical fields, for opinion and advice.

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.

GS-07:  Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-5 in the Federal Service. Specialized experience is experience that equipped the candidate with the particular knowledge, skills and abilities to successfully perform the duties of the position being filled. Examples of qualifying specialized experience include:

Demonstrating the knowledge and ability to develop, examine, investigate, adjudicate, and/or authorize claims for disability and/or death compensation; Examining and developing reports of disability and death and obtaining documentation; verifying benefits payments; Ability to interpret medical reports and to develop and evaluate pertinent medical facts and evidence from medical reports and diagnostic tests and studies; Applying and interpreting laws, regulations, policies, precedents, and other criteria for disability and death cases; Ability to prepare drafts of brief findings of fact and drafts of proposed questions.

GS-09: Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-07, in Federal Service or private sector.  Specialized experience is experience that equipped the candidate with the particular knowledge, skills and abilities to successfully perform the duties of the position being filled. Examples of qualifying specialized experience include:

Experience adjudicating a broad range of disability and death claims, making determinations on non-medical and/or medical issues.  Examines claims for factual and legal correctness.  Receives and examines forms, i.e., CM-911, CM-912, and CM-911a and all appropriate certificates such as birth, death, marriage certificates and autopsy reports.  Demonstrates a knowledge of medical terms and findings (working knowledge of the human anatomy and its function, the etiology and pathology of disease), and the relationship of disability to the ability to work. Secures medical reports and evaluates medical evidence and medical documents to determine the extent of the claimant’s disability.  Reviews and processes widow’s claims.  Experience determining compensation due, and authorizing and setting up payments.  Experience entering appropriate claims development, adjudication, and compensation data.  Demonstrate the ability to develop and evaluate pertinent medical facts and evidence from medical reports, diagnostic tests, and studies, and to apply and interpret laws, regulations, policies, precedents, and other criteria for disability and death cases.

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