Claims Specialist II

  • Claims Specialist II
  • What will I be doing?
  • Do I qualify?
  • Can I be successful?
  • Benefits
  • How do I apply?
Class Number: 
0782
Exam Components: 
Rating of Education & Experience, 100%
Annual Salary Range:
$32,148.00 – $44,352.00
Twice-a-Month Salary Range:
$1,339.50 – $1,848.00
Pay Grade: 
A19

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Definition

This is professional interviewing and related work in the unemployment insurance benefit/claims program of the Missouri Division of Employment Security.

Job Duties

Assumes responsibility for the more difficult and complex activities involved in securing and evaluating information required to process a variety of state and federal unemployment insurance claims, shared work claims, and claims for training, subsistence, and transportation allowances under various employability programs.

Files claims under various state and federal unemployment insurance programs; investigates and adjudicates disputed claims; reviews new information to determine whether to process an appeal or reconsider a determination; verifies eligibility for federal allowance payments; investigates overpayments on erroneous and fraudulent claims; prepares case materials needed for prosecuting more flagrant cases of fraudulent claims filing; and solves other complex claims processing problems in compliance with state and federal laws and regulations.

Directs the conversion of all mail and fax correspondence to electronic documents for Regional Claims Centers and provides guidance for proper indexing of complex correspondence.

Secures detailed information from claimants and enters that data into the computer system; determines the type of unemployment claim to be filed under the various state and federal unemployment insurance programs.

Secures, documents, and investigates detailed and sensitive information from claimants involved in disputed claims, including such complicated issues as separation from work, availability for work, refusal of work, participation in a labor dispute, and overpayment investigations.

Secures and documents additional technical information from employers and other interested parties by means of telephone interviews and correspondence to obtain complete facts of the issues involved.

Obtains facts and issues determinations relevant to a trainee’s eligibility status for allowances under the various employability programs.

Evaluates information secured, applies proper section of the law to the facts, and prepares non-monetary determinations for forwarding to all interested parties.

Reviews and evaluates new information received after a determination has been issued to determine if the proper course of action is to process an appeal or reconsider a determination.

Interviews claimants to secure information concerning previous wages earned and weeks worked for use in determining additional wage credits to which they may be entitled or for the overpayment of benefits.

Corresponds and communicates with claimants, employers, Central Office, and state and federal agencies to correct errors, resolve problems, and facilitate the processing of claims.

Receives and answers telephone and written inquiries regarding unemployment insurance.

Establishes, maintains, and purges files on disputed claims to ensure prompt processing.

Attends various training sessions and meetings to remain aware of program procedures and law changes.

Assists in preparation of case materials and coordinates with prosecuting attorneys throughout the state for presentation of cases where criminal charges are filed against individuals who have fraudulently filed claims for unemployment insurance.

Assists in training new agency staff in filing various types of unemployment insurance claims, the fact-finding and determination writing processes, and related procedures.

Applies established procedures for control of overpayment and fraud on all types of claims.

Receives assignments in cases of potential overpayment of erroneous or fraudulent claims; collects and evaluates information; establishes facts and makes recommendations and determinations consistent with law.

Resolves complex claims processing problems in compliance with state and federal laws and regulations.

Studies new and revised agency procedures, rules, laws, regulations, and other program changes contained in operating manuals to maintain currency of knowledge and information.

Interviews claimants with outstanding overpayments and arranges for restitution including civil action.

Provides basic oversight and review of the work performed by employees in lower-level positions.

Receives minimum supervision; however, the employee is expected to exercise independent judgment and initiative within the framework of established state and federal laws and agency policies and procedures.

Performs other related work as assigned.

Areas of Interest: 
BUSINESS SERVICES

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(The following minimum qualifications will determine merit system eligibility.  Allowable experience and education substitutions are provided in italics below the corresponding minimum qualification statement; no other substitutions will be permitted.  These minimum qualifications may also be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers.)

One or more years of experience as a Claims Specialist I or Contributions Specialist I with the Missouri Division of Employment Security; and possession of a high school diploma or proof of high school equivalency.

OR

A Bachelor’s degree from an accredited college or university with a minimum of 15 earned credit hours in one or a combination of the following:  social sciences, Education, or Public or Business Administration; and,

One or more years of technical experience in the fields of social services, social welfare, education, community organization, or related areas; or in business, personnel, or public administration involving public contact.

(24 earned graduate credit hours from an accredited college or university in the specified areas may substitute for the required experience.)

(Additional qualifying experience may substitute on a year-for-year basis for deficiencies in the required college education.)

Please note that documentation that supports your eligibility (i.e. transcripts, employment records, etc.) may be required at any time during the application and hiring process. If you do not possess the minimum qualifications, please consider one of many other employment opportunities with the State of Missouri.

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Key Skills

Do you possess the key skills which are considered essential for successful employment in this classification?

Intermediate knowledge of interviewing and investigative techniques and procedures required in the processing of claims for unemployment insurance.

Intermediate knowledge of the principles, objectives, and regulations underlying the unemployment insurance program and the applicable state and federal laws.

Intermediate knowledge of office procedures, practices, and equipment.

Intermediate knowledge of computer and related equipment for data input, retrieval, and word processing.

Ability to obtain and document essential facts clearly and concisely, evaluate information, and make determinations on the basis of established rules and precedents.

Ability to organize and prioritize workload to meet assigned timeframes and adapt to changes in policy, procedures, and work assignments

Ability to communicate effectively with agency staff, claimants, employers, and other persons.

Ability to work rapidly and accurately.

Ability to understand complex laws, procedures, and regulations pertaining to the Division of Employment Security benefit/claims program.

Ability to maintain effective working relationships with co-workers, claimants, employers, and their representatives, such as accountants and attorneys.

View Class Specification Document

The following link will provide you with general information about State of Missouri employee benefits.

View benefits

View Class Specification Document