Workers Compensation Claims Examiner - Recent Graduate

DEPARTMENT OF LABOROffice of Workers' Compensation ProgramsDivision of Energy Employees' Occupational Illness Compensation

College Graduate appointments are permanent competitive service appointments.

Relocation/PCS funds are not authorized.

Selections can be made using this announcement.

Additional selections may be made using this announcement.

This position is in the bargaining unit.

Salary posted reflects nationwide locality pay range.

Once the selection has been made, the salary will be set per the selectee's home worksite.

Clarification from the agencyOpen to individuals who have completed a bachelor's or graduate degree within the previous two years or Veterans who have completed a bachelor's or graduate degree and have an intervening period of obligated service of at least four years in the uniformed services. The two-year eligibility period begins on the date of discharge or release from the uniformed service. (See the Qualifications section for further details.)

DutiesMajor duties of this position include:Working under close technical review of senior team members, the incumbent examines routine requests for compensable medical services and treatments for a full-range of accepted occupational illnesses to include, but not limited to, claims for Home Health Care, Hospice, and requests for Durable Medical Equipment as they relate to accepted conditions for claimants covered by the EEOICPA. Conducts fact-finding to review clear-cut evidence submitted in support of an initial home health care claim or other medical authorization request, and with substantial support of senior team members, determines if the submission includes sufficient factual medical evidence to support authorization. Assists in taking appropriate development actions.Gathers, identifies, and analyzes clear-cut medical evidence with or subsequent to the initial home health care claim or authorization request and provides information to senior team members to development appropriate actions. Serving in a developmental capacity, the incumbent participates in verifying that the claim or request involves an accepted medical illness/injury and identifying the presence of potential consequential illnesses.Contacts stakeholders (e.g., claimants, representatives, medical officials, etc.) to obtain corrected or supplementation documentation to support the claim/request (e.g., home health care, durable medical equipment, travel, etc.) and to resolve conventional issues. Assists senior examiners or team lead in the development of questions for physicians in cases that involve the need for supplemental medical information, resolution of conflicting medical documentation, or medical authorization requests. Participates in initiating referrals to medical consultants and assists senior staff in preparing questions and statements of accepted facts. Reviews returned medical reports that are routine in nature in order to ensure the medical consultant has answered all questions posed for decision-making.Conducts studies on routine medical authorization processes and makes recommendations to resolve problems in work processes. Applies judgment in interpreting and adapting established workers' compensation policies and procedures to these specific work assignments. May provide guidance, instruction, and/or information on EEIOCP policies and procedures to internal stakeholders.At the entry-level, the incumbent participates in the review of surveillance and audit reports generated by the branch (Program Integrity Analysts), Office of Inspector General (OIG), Office of the Solicitor (SOL), or other reporting entities that identify potential duplication in services and areas of potential fraud. Identifies, analyzes, and recommends changes to help reduce or eliminate potential waste, fraud, or abuse.In conjunction with senior team members, the incumbent participates in the review of remanded cases from the Final Adjudication Branch. Based on the reason for the remand, the incumbent provides assistance to senior staff in developing the claim further in order to account for any changes in circumstances or facts around benefits claimed or changes in EEOICPA provisions.Provides support and/or participates in preparing written and oral presentations for meetings, outreach events, or conferences whose attendees are medical providers, medical vendors, claimants, advocates, medical committees, employer and industry associations, labor unions, and other parties interested in DEEOIC medical authorization processes and procedures.

Please see full position requirements on usajobs.gov by clicking apply.