JOB TITLE: UNEMPLOYMENT COMPENSATION CLAIMS EXAMINER

JOB CODE: 06610

SERIES NATURE OF WORK: The Unemployment Compensation Claims job series describes work in a call center environment processing and determining unemployment compensation eligibility under the Pennsylvania Unemployment Compensation (UC) Law.

DEFINITION: This is advanced technical work in investigating, processing, and issuing determinations of eligibility for unemployment compensation benefits within the confines of Pennsylvania Unemployment Compensation (PA UC) Law.

An employee in this job examines established claims for UC benefits and makes eligibility determinations. Work involves interviewing claimants, employers, and other interested parties to gather and develop the facts regarding claim issues; confirming applicable program types and wage periods; identifying, investigating, and correcting overpayments; and participating in appeal hearings. Work also involves documenting findings, determining the appropriate payment amount, identifying issues that require further action, and completing mandated reporting requirements. Work includes providing other call center staff with direction on claims processing functions. Work is reviewed by an Unemployment Compensation Claims Supervisor through conferences, meetings, observation, and the evaluation of completed work for adherence to established laws, regulations, policies, procedures, and standards. Work is also subject to audits by state and federal auditors to evaluate if the department is meeting Federal Department of Labor quality standards within the guidelines of PA UC Law.

   DISTINGUISING CHARACTERISTICS:

     • Work in this job is distinguished from the lower-level job based on responsibility for making eligibility determinations, participating in appeal hearings, researching suspected fraud claims, and examining claims involving complex issues including non-separation reasons, overpayments, and suspected fraud cases.

EXAMPLES OF WORK: (NOTE: The examples of work are representative of the work, but every position classified to this job may not perform all examples of work listed. Conversely, this is not an all-inclusive list of work examples.)

• Makes eligibility determinations for various UC programs based on multiple factors including separation reason, weekly income, wage types, and programs.

• Interviews claimants, employers, and other interested parties to obtain facts relating to eligibility for initial or continued benefits.

• Makes determinations of eligibility and adjustments for disputed claims based on laws, regulations, and procedures.

• Investigates claims for overpayment, evaluates whether an act of fraud occurred, and makes recommendations on the type of action to be taken, up to the level of prosecution.

• Reviews and evaluations case facts and assigns credibility to a given party to resolve the conflicting statements from different parties.

• Represents the agency before Appeals Referees and the Unemployment Compensation Board of Review for claims that have been appealed; and serves as a representative for the Department in other magisterial settings.

• Provides direction and advice to other call center personnel.

• Performs related work as required.

REQUIRED KNOWLEDGES, SKILLS, AND ABILITIES:

• Knowledge of federal laws, policies, and procedures applicable to UC programs.

• Knowledge of UC claims processing and adjudication practices.

• Knowledge of interviewing techniques required to gather information.

• Knowledge of legal precedents relating to the granting of UC benefits.

• Knowledge of the use and functionality of Microsoft Office Suite software.

• Ability to analyze and interpret written information.

• Ability to analyze and interpret numerical data.

• Ability to perform mathematical calculations.

• Ability to communicate effectively orally.

• Ability to communicate effectively in writing.

• Ability to establish and maintain effective working relationships.

MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities)

• One year of experience as an Unemployment Compensation Claims Intake Interviewer (commonwealth title);

or

• Four years of customer service or office support experience which includes one year of experience in the application of Unemployment Compensation law;

or

• An equivalent combination of experience and training which includes one year of experience in the application of Unemployment Compensation law.