WORKERS' COMPENSATION TECHNICIAN II

DEFINITION

This is advanced technical work in the Department of Labor and Industrial Relations involving the securing and evaluation of information required for the processing of claims, First Reports of Injury and ancillary documents, or comparable highly technical work involving a variety of independent functions and processes, in the Division of Workers' Compensation's Injury Processing or Crime Victims units.

An employee in this class performs a variety of duties involving the securing and evaluation of initial reports and claims, as well as information required to continue existing cases through the adjudication process or to issue determinations of eligibility or denial of awards/settlements based on statutes, rules and regulations. Work at this level involves resolving the more complex case processing problems or the independent performance of highly technical work in a complex area. Work in the Injury Processing unit involves initiating cases by processing Claims for Compensation and First Report of Injury information, and preparing materials needed for lower level Technicians to proceed with the case. Work in the Crime Victims unit involves reviewing claims in an effort to obtain pertinent information regarding the eligibility status and payment/award amounts to recipients of this program and to recover subrogation rights for the Crime Victims' Compensation Program. Work may involve acting as a lead worker, providing training to and/or assisting lower level Workers' Compensation Technicians. General supervision is provided by Workers' Compensation Technician Supervisor or other designated superior; however, the employee is expected to work independently in the performance of assigned responsibilities within established guidelines.

Any one position may not involve all of the specified duties or knowledges, skills and abilities, nor are the listed examples exhaustive.

EXAMPLES OF WORK

Reviews and evaluates new information received for amended cases, bankruptcies, relocated insurance companies and employers and fraudulent activities.

Obtains and documents detailed information regarding separation from work, multiple employers and insurance companies, determination of the type of case to be filed, and determination of how to handle issues related to employer bankruptcy.

Sets up trading partner agreements between the Division and vendors; initiates the test phase of electronic forms submission; reviews, accepts, processes and downloads data submitted by vendors; sends electronic notifications of workers' compensation cases; and requests additional information or corrections to case information.

Acts as a lead worker; trains and assists lower level Workers' Compensation Technicians.

Identifies the type of benefit owed and medical costs incurred.

Ensures that all review processes have been completed in accordance with statutory requirements.

Examines the accuracy of case information; determines if additional information is needed and, if necessary, refers case to the Division's Fraud unit.

Monitors and reviews ongoing medical, legal and monetary issues related to claims; makes determinations of solvency for self-insured employers.

Consults with supervisors to determine if a case should be referred to a local adjudication office.

Interviews and corresponds with victims, claimants, providers, law enforcement, victims' advocates, attorneys or prosecutors to obtain information necessary for making determinations.

Reviews claims for possible restitution and subrogation reimbursement; calculates and prepares revenue transmittals for restitution, refund and subrogation settlement deposits.

Maintains files of correspondence to county prosecutors; maintains logs of monies received for restitution, refunds, subrogation, donations, etc.

Prepares restitution reports, comprehensive fiscal statistical reports and other reports as needed.

Performs other related work as assigned.

KNOWLEDGE, SKILLS AND ABILITIES

Thorough knowledge of state laws and regulations governing the processing and adjudication of Injury Processing or Crime Victims' Compensation programs.

Thorough knowledge of the policies, procedures and operations of the Division of Workers' Compensation.

Thorough knowledge of the computer systems utilized in the Division of Workers' Compensation.

Considerable knowledge of database case management applications.

Considerable knowledge of Workers' Compensation claims processing.

Considerable knowledge of basic legal and medical terminology .

Considerable knowledge of office practices, procedures, equipment and desktop computer applications .

Considerable knowledge of basic bookkeeping and accounting principles and practices.

Ability to provide training and/or assistance to lower-level Workers' Compensation Technicians.

Ability to work with electronically submitted data on a variety of databases.

Ability to independently gather relevant case information.

Ability to exercise sound judgment in the analysis of case information in order to expedite legal compliance issues and reduce delay in case adjudication.

Ability to explain and apply rules, regulations and policies governing the processing of Workers' Compensation Injury or Crime Victims' Compensation claims.

Ability to work rapidly and accurately in processing a large volume of documents.

Ability to communicate effectively and to prepare clear and concise reports.

Ability to establish and maintain effective working relationships with other employees, customers, attorneys, insurers, health care providers, prosecutors, law enforcement officials and the public.

EXPERIENCE AND EDUCATION QUALIFICATIONS

(The following entrance requirements are used to admit or reject applicants for merit system examinations, or may be used to evaluate applicants for employment in positions not requiring selection from merit system registers. When applicable, equivalent substitution will be allowed for deficiencies in experience or education.)

Eighteen months of experience as a Workers' Compensation Technician I.

OR

Four years of technical or clerical experience processing workers' compensation or insurance claims; as a paralegal or legal assistant; reviewing police reports, witness statements and/or criminal history reports; or closely related areas, including eighteen months at the level of a Workers' Compensation Technician I; and possession of a high school diploma or a GED certificate. (College coursework from an accredited college or university with specialization in social sciences, business or public administration, or closely related areas may be substituted on a year-for-year basis for the required general experience. Training from a vocational or business school in office management, secretarial science or a closely related field may be substituted for up to a maximum of twelve months of the stated general experience).

(Effective 8/1/05)