Workers' Compensation Claims Examiner

Summary

This position is located in the Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP).

These positions are 100% remote. Salary posted reflects nationwide locality pay range. Once selections are made, the salary will be set according to the selectee's home worksite.

This position is inside the bargaining unit.

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Help Duties

The OWCP mission is to protect the interests of workers who are injured or become ill on the job or as a result of employment, or their families, by making timely, appropriate, and accurate decisions on claims and providing prompt payment of benefits to eligible claimants.

Major duties of this position include:

• Conducts fact-finding to properly gather, assess, analyze and adjudicate a broad range of disabling occupational diseases and illnesses, and death claims assigned.
• Develops and makes determinations on the proper disposition of claims for assigned cases.
• Reviews and adjudicates claims to make determinations on entitlement to benefits and medical issues for which there are established precedents or where factual and medical opinion clearly supports the claim.
• Examines medical, employment, and other factual evidence for claims for benefits involving work-place illnesses for factual sufficiency and legal correctness to determine if the compensation claim and/or medical benefit claim meets the criteria outlined in established policies, procedures, or other guidelines.
• Employs standard investigative approaches to obtain information, evidence, and other documentation related to claims.
• Reviews and evaluates a variety of evidentiary documents (e.g., narrative medical reports commenting upon the relationships of the disability to the implicated employment factors, history of claimant's disability and health history, specifics of employment felt to be the cause of injury, job descriptions, workplace exposures, comments on the veracity of the claimant's statements, employment records, letters or certificates of medical necessity, etc.) from a variety of sources submitted with or subsequent to the initial claim.
• Prepares correspondence and maintains working relationships with claimants, employers, physicians, medical providers, representatives, attorneys, and other sources to obtain missing or supplemental medical and employment documents, to clarify information, and to secure additional factual and medical information needed to adjudicate the claim.
• Prepares statements of accepted facts and refers cases for medical opinion to the program medical advisor/consultant for second opinions, independent medical examinations and/or case reviews that may or may not require a claimant to undergo a physical examination, to clarify medical opinions or to resolve conflicts in medical opinion.
• Makes recommended determinations on claims ensuring that decisions are consistent with established guidelines.
• Processes payments of compensation and impairment awards in accordance with the appropriate program procedural manual.
• Provides technical assistance and advice to claimants and/or their representatives on eligibility for benefits.
• At the GS-9 grade level, assignments are developmental; as the incumbent progresses, the assignments become more difficult and complex at the GS-11 and GS-12 full journeyman.
  
  

Help Requirements

Conditions of Employment

• Must be at least 16 years old.
• Must be a U.S. Citizen.
• Candidate required to obtain the necessary security/investigation level.
• Requires a probationary period if the requirement has not been met.
  
  

Qualifications

In describing your experience, please be clear and specific. Position titles alone cannot be used to determine if you are qualified. Please list dates in MM/DD/YYYY format. This is imperative in determining if you have at least one year of creditable specialized experience. Dates will not be assumed.

At the GS-9 grade level: Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-7, in the Federal Service. Examples of specialized experience include:

• Receiving and evaluating forms and supporting evidence for completeness and development of benefit claims.
• Experience with medical terms and findings, causes of diseases, treatment methods and probable results and relationship to occupation.
• Writing correspondence of a business nature to internal and external customers seeking information and/or recommendations or decisions
• Representing an organization to provide advice or guidance on technical or complex issues to customers.
  
  

Or

Have earned a Master's or equivalent graduate degree, or completed 2 full years of progressively higher-level graduate education leading to such a degree, or LL.B. or J.D., if related,

Or

A combination of graduate education and experience.

Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level.

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 coursework requirements for this position. Click Evaluation of Foreign Education for more information.

Additional information

This position is inside the bargaining unit. If the duty location is within the Washington, D.C. metropolitan area, the position will be included in the Local 12, AFGE bargaining unit. If the duty location is outside the Washington, D.C. metropolitan area, the position will be included in the NCFLL bargaining unit.

The mission of the Department of Labor (DOL) is to protect the welfare of workers and job seekers, improve working conditions, expand high-quality employment opportunities, and assure work-related benefits and rights for all workers. As such, the Department is committed to fostering a workplace and workforce that promote equal employment opportunity, reflects the diversity of the people we seek to serve, and models a culture of respect, equity, inclusion, and accessibility where every employee feels heard, supported, and empowered.

Refer to these links for more information: GENERAL INFORMATION, REASONABLE ACCOMMODATION, ADDITIONAL DOCUMENTATION, FORMER FEDERAL EMPLOYEES

As a condition of employment, all personnel must undergo a background investigation for access to DOL facilities, systems, information and/or classified materials before they can enter on duty: BACKGROUND INVESTIGATION

The full promotion level is GS-12. Click here for Career Ladder Promotion Information

Based on agency needs, additional positions may be filled using this vacancy.

The Department of Labor may use certain incentives and hiring flexibilities, currently offered by the Federal government to attract highly qualified candidates. Click here for Additional Information.

The Fair Chance Act (FCA) prohibits Federal agencies from requesting an applicant's criminal history information before the agency makes a conditional offer of employment. If you believe a DOL employee has violated your rights under the FCA, you may file a complaint of the alleged violation following our agency's complaint process Guidelines for Reporting Violations of the Fair Chance Act. Note: The FCA does not apply to some positions specified under the Act, such as law enforcement or national security positions.

All Department of Labor employees are subject to the provisions of the Drug-Free Workplace Program under Executive Order 12564 and Public Law 100-71.

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Office of Workers Compensation Programs

200 Constitution Avenue NW

Washington, DC 20210

US