State Workers' Insurance Fund Claims Representative

State Workers' Insurance Fund Claims Representative

Salary : $45,907.00 - $69,203.00 Annually

Location : Philadelphia County, PA

Job Type : Non-Civil Service Permanent Full-time

Job Number : N-2025-35086

Department : Department of Labor & Industry

Division : LI SWIF Philadelphia District Office

Worksite Address : 801 Market Street, Suite 4101, Philadelphia, Pennsylvania, 19102

Contact Name : Felicia Newbury

Contact Email : fnewbury@pa.gov

The Position

Are you ready to take the next step in your career? If so, consider joining the Department of Labor & Industry, State Workers' Insurance Fund (SWIF) as a Claims Representative. This position gives you the opportunity to investigate, process, and manage reported work-related claims or injuries for employees of policy holders covered by the State Workers' Insurance Fund for the purpose of determining compensability. If you are an analytically minded professional with a keen eye for detail, we need you on our team!

Description Of Work

As a Claims Representative, your focus will be on completing investigations for reported work related or injury incidents or claims; processing acceptance or denial within 48 hours of receiving the assignment. The investigation must include consideration of the course and scope, employment relationship and may include, but should not be limited to vehicle accident, coming and going, if appropriate to the assigned office, firefighter affiliation, undocumented worker, misclassification, and all other information that is necessary to determine compensability of the present claim. You will have the opportunity to monitor and control all aspects of the claim to conclusion in accordance with established authority and procedure. You can expect to handle all aspects of minor disability or lost time claims with closed periods of disability or anticipated lost time of less than eight weeks.

Additional duties include :

• Making determinations to identify potential fraud, documenting and reporting all suspected fraud to the SWIF fraud investigator and supervisor
• Identifying and making recommendations to supervisor when identified excess use of Physical Therapy or Durable Medical Equipment supplies have been ongoing for an extended or excessive period of time
• Ensuring claim intake data is complete and accurate including but not limited to claimant data, employer data, NAICS and incident information
• Contacting appropriate parties related to the reported claim including claimant, employers, doctors, hospitals, and witnesses to determine eligibility for workers' compensation benefits

Work Schedule And Additional Information

Full-time employment

Work hours are 8 : 00 AM to 4 : 00 PM, Monday - Friday, with 30-minute lunch.

Telework : You may have the opportunity to work from home (telework) part-time. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Philadelphia. The ability to telework is subject to change at any time. Additional details may be provided during the interview.

Salary : In some cases, the starting salary may be non-negotiable.

You will receive further communication regarding this position via email. Check your email, including spam / junk folders, for these notices.

Required Experience, Training & Eligibility

Qualifications

Minimum Experience and Training Requirements :

Two years of clerical work experience that includes collecting, recording, compiling, or preparing documents for medical, health, or work-related insurance claims;or

An equivalent combination of experience and training.

Additional Requirements :

You must be bilingual / fluent in Spanish.

You must demonstrate the ability to adhere to the values and ethics of the Department of Labor and Industry.

You must demonstrate the ability to work with professionalism, discretion, and good work ethic.

You must have solid written and verbal communication skills.

You must show initiative and problem-solving skills.

You must be able to perform essential job functions.

How to Apply :

Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience / education).

If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.

Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.

Failure to comply with the above application requirements may eliminate you from consideration for this position.

Veterans :

Pennsylvania law (51 Pa. C.S. 7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.pa.gov / agencies / employment / how-to-apply.html and click on Veterans.