Workers' Compensation Claims Examiner
Occasional travel - Less than 25% for training purposes
Relocation expenses reimbursed No
Applicants must meet all legal and regulatory requirements. Reference the "Required Documents" section for additional requirements.IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.
Specialized experience is experience that equipped the candidate with the particular knowledge, skills and abilities to successfully perform the duties of the position, and that is typically in or related to the work of the position to be filled.
GS-07: Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, 05, in the Federal Service. Experience adjudicating claims; receiving and evaluating medical reports and supporting medical documents. Experience determining the amount of compensation, the extent of the disability and the length of time compensation is to be paid. Experience setting up payments. Experience entering claims development, adjudication and compensation into the automated system. Experience preparing correspondence to claimants, witnesses, doctors, employers, etc., seeking information;
1 full year of graduate level education or superior academic achievement;
A combination of education and experience.
GS-09: Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, 07, in the Federal Service. Experience adjudicating a broad range of disability and death claims. Experience making determinations on nonmedical and/or medical issues. Examines claims for factual and legal correctness. Receives and examines forms, i.e. CA-16 or 20, CA-5 and CA-6 and all appropriate certificates such as, birth, death, marriage certificates, and autopsy reports. Secures medical reports and reviews case to determine the extent of claimants disability. Reviews and processes death claims cases. Experience setting up payments and authorizing burial allowances. Receiving and evaluating medical evidence, reports and medical documents. Authorizing monetary compensation. Experience determining the pay rate to be used for compensation purposes and authorizes payment. Experience entering appropriate claims development adjudication compensation adjustment data. Experience demonstrating a knowledge of medical terms and findings (working knowledge of the human anatomy and its function, the etiology and pathology of injury and disease), causes of diseases, treatment methods and probable results, relationship of disability to the ability to work; or work that demonstrates the ability to develop and evaluate pertinent medical facts and evidence from medical reports and diagnostic tests and studies, and to apply and interpret laws, regulations, policies, precedents, and other criteria for disability and death cases;
Master’s or equivalent graduate degree or 2 full yrs of progressively higher level graduate education leading to such a degree or LL.B. or J.D., if related;
A combination of education and experience.
GS-11: Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, 09, in the Federal Service. At the GS-11 level: In addition to the GS-09 experience the candidate must demonstrate experience developing, adjudicating, and authorizing claims with highly controversial medical and factual issues. Experience developing all necessary evidence on difficult or highly controversial issues through correspondence, directed investigations, and the consideration of expert medical reports. Experience with medical terms and findings, causes of diseases, treatment methods and probable results, relationship of disability to ability to work; or demonstrated the ability to develop and evaluate pertinent medical facts and evidence and to apply and interpret laws, regulations, policies, precedents, and other criteria for disability and death cases or provided a knowledge of the pertinent workers' compensation laws, and of the controlling policies, principles, regulations, and precedents which embody that specialized branch of law generally referred to as "worker' compensation."
The foregoing may have been gained from: (1) experience in a Federal or State disability, death, workers' compensation, pension, or other similar program; (2) practice of law which included cases related to such programs or (3) experience in an insurance company administering and adjudicating claims under similar programs;
Ph.D. or equivalent doctoral degree or 3 full yrs of progressively higher level graduate education leading to such a degree or LL.M., if related;
A combination of education and experience.
College Transcript and Evaluation of Foreign Education - The Department of Labor does not recognize academic degrees from unauthorized secondary schools or post-secondary institutions that are not accredited by an accrediting body recognized by the Department of Education. Any applicant falsely claiming an academic degree from an accredited school will be subject to actions ranging from disqualification from federal employment to removal from federal service. If your education was completed at a foreign college or university, you must show comparability to education received in accredited educational institutions in the United States and comparability to applicable minimum course work requirements for this position. Click Evaluation of Foreign Education for more information.Read more
You will be evaluated for this job based on how well you meet the qualifications above.
If you meet the minimum qualifications, you will be evaluated against the evaluation factors below and will be placed into a category based on your vacancy question responses.
Category A - Meets the basic qualification requirements for the vacancy and has successful experience in the same or similar job that has demonstrated superior proficiency in applying critical competencies required by this position to work of increased levels of difficulty and complexity.
Category B - Meets the basic qualification requirements for the vacancy and demonstrates satisfactory proficiency in the critical competencies required by this position.
Category C - Meets the specialized experience described in the minimum qualifications requirements section of this announcement and demonstrates proficiency in the basic competencies.
Evaluation Factors (Competencies) - All qualified applicants will be evaluated on the following key competencies (click Evaluation Tools for information):
Problem solving: Identifies problems, determines accuracy and relevance of information; uses sound judgment to generate and evaluate alternatives, and to make recommendations.
Program Knowledge - Knowledge and application of the laws, regulations, court procedures, precedents, legal practices and documents, government regulations, executive orders, agency rules, government organization and functions.
Self-Management - Sets well-defined and realistic personal goals; displays a high level of initiative, effort, and commitment towards completing assignments in a timely manner; works with minimal supervision; is motivated to achieve; demonstrates responsible behavior.
Customer Service: Works with customers to provide information or assistance.
Oral Communication: Express information to individuals or groups effectively.
Interpersonal Skills: Relates well to people from varied backgrounds and different situations.
Writing: Recognizes or uses correct English grammar, punctuation, and spelling; communicates information in a succinct and organized manner; produces written information, which may include technical material that is appropriate for the intended audience.
Decision Making - Makes sound, well-informed, and objective decisions; perceives the impact and implications of decisions; commits to action, even in uncertain situations, to accomplish organizational goals; causes change.
The information you provide may be verified by a review of your work experience and/or education, by checking references and through other means (ex. interview). The examining Human Resources Office (HRO) makes the final determination concerning applicant ratings. Your resume MUST provide sufficient information to substantiate your responses to the vacancy questions. If not, the HRO may amend your responses to more accurately reflect the level of competency indicated by the content of your resume. Your evaluation may also include a review by a Human Resources Specialist or panel and may include other assessments (ex. interview, panel review, written test, writing sample, etc.)
INFORMATION FOR ICTAP/CTAP ELIGIBLES ONLY: If you are eligible for special priority selection under ICTAP/CTAP, you must be well-qualified for the position to receive consideration. ICTAP/CTAP eligibles who are placed into Category B or higher will be considered "well-qualified".
Click Application of Veterans Preference for Category Rating Jobs for more information.
To preview questions please click here.