CLAIMS EXAMINER

Claims Examiner

The Fire Department of the City of New York (FDNY) is the largest Fire Department in the United States and universally is recognized as the world's busiest and most highly skilled emergency response agency. The Department's main goal is to provide fire protection, emergency medical care, and other critical public safety services to residents and visitors in the five boroughs. FDNY members are sworn to serve and protect life and property, and the Department works to continually educate the public in fire, life safety and disaster preparedness, along with enforcing public safety codes. Since its inception in 1865, FDNY has helped lead efforts to make New York the safest big city in the nation. This accomplishment requires a steadfast and daily commitment to maintaining the Department's core values. The Fire Department, City of New York (FDNY), seeks a full-time Workers Compensation Benefits Examiner in the Bureau of Health Services. Reporting directly to the FDNY Claims Supervisor the successful candidate will :

• Examine and process WTC claims for payment in accordance to NYS Workers' Compensation Board rules and NIOSH rules
• Calculate payment adjustments in accordance with established guidelines and fee schedules
• Ensure compliance of quality assurance measures when processing claims
• Investigate inquiries and mitigate resolution of outstanding cases
• Process actions utilizing computerized processing software
• Serve as liaison to outside agencies / providers in conveying information and providing feedback on worker's compensation issues
• Other tasks as assigned by the supervisor, that may include creating spreadsheets to track incoming and outgoing requests and filing

Qualifications

1. An associate degree or completion of 60 semester credits from an accredited college or university, including or supplemented by 6 semester credits in mathematics, statistics, accounting, and / or actuarial science; or 2. A four-year high school diploma or its educational equivalent and one year of satisfactory full-time experience implementing the provisions of a workers' compensation or retirement or medical benefits plan, involving the use of mathematical, statistical, actuarial, or accounting computations; or 3. A combination of education and / or experience equivalent to "1" or "2" above. Satisfactory completion of 30 semester credits from an accredited college, including 3 semester credits in mathematics, statistics, accounting and / or actuarial science may be substituted for 6 months of the full-time experience as described in "2" above. However, all candidates must possess at least a four-year high school diploma or its educational equivalent. SPECIAL NOTE : A. Upon completion of one year of satisfactory continuous service in Assignment Level Ia, employees shall be assigned to Assignment Level Ib. B. To be eligible for placement in Assignment Level Ib or II, individuals must have, in addition to meeting the minimum requirements, either : 1. One additional year of satisfactory full-time experience implementing the provisions of a workers' compensation or retirement or medical benefits plan involving the use of mathematical, statistical, actuarial, or accounting computations; or 2. A baccalaureate degree from an accredited college including or supplemented by 6 semester credits in mathematics, statistics, accounting and / or actuarial science. SPECIAL NOTE : C. To be eligible for placement in Assignment Level III, individuals must have, in addition to meeting the minimum requirements, either : 1. Two additional years of full-time experience as described in "Note B. 1" above; or 2. A baccalaureate degree from an accredited college including or supplemented by 6 semester credits in mathematics, statistics, accounting and / or actuarial science and one additional year of satisfactory full-time experience as described in "Note B. 1" above.

Additional Information

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.