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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00089591 |
Description Activated On: 8/23/2024 2:07:08 PM |
Position Purpose: Describe the primary purpose of this position and how it contributes to the organization’s objectives. Example: Provides clerical and office support within the Division to ensure its operations are conducted efficiently and effectively. Under the direction of the Claims Review Unit Supervisor for the Victims Compensation Assistance Program, Office of Victims' Services, this individual assists in the approval/disapproval of compensation claims. Works in close coordination with Claims Review Unit Supervisor, Legal Counsel, VCAP Program Manager, and VCAP Supervisors on the processing of claims. |
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Description of Duties: Describe in detail the duties and responsibilities assigned to this position. Descriptions should include the major end result of the task. Example: Types correspondence, reports, and other various documents from handwritten drafts for review and signature of the supervisor. Claims Review 80% Responsible for claims processing, writing Reports and Determinations on claims, and rendering a decision based on a preponderance of evidence. Responsible for writing Reconsiderations, Reaffirmations and Denials based on documentation from law enforcement and others as needed to effectuate decisions on claims. Responsible for the initial review and determination of all contribution cases prior to review by the Supervisor and/or Legal Counsel. Assists claim specialists, as needed, in the review loss of support claims to ensure eligibility. Is a member of the Claims Review Team (CRT) which consists of Office Director, Deputy Director, VCAP Program Manager, Claims Review Unit Supervisor, Direct Victims' Services Coordinator, and VCAP Supervisors. The CRT meets bi-weekly to review complex claims as well as appeals received by the Program for reconsideration of denials and contribution. Employee is responsible for reviewing, analyzing, and presenting summaries of complex claims to the CRT to assist in the decision making process. Makes recommendations on claims for denial. Makes recommendations on claims for contribution prior to approval by Legal Counsel. Adhere to established regulations and policies in determining claim eligibility to ensure consistency in the eligibility determination of all VCAP claims. Testify at formal hearings conducted before a hearing examiner when a claimant contests a determination. Works closely with Legal Counsel on testimony in support of the Agency’s position. Claims Process 20% Assists the supervisor, as requested with the oversight of the process for requesting and securing investigative reports for all crime incidents reported to and investigated by the Pennsylvania State Police. Maintains a record of all requests and consistently monitors requests to ensure timely and efficient claims processing. Sign and seal subpoenas. Provide quality customer service. Assist the supervisor and staff with providing on-site victims compensation assistance for incidents of mass violence. Assist the supervisor, as requested, with providing technical assistance throughout the Commonwealth, at scheduled training session, "in-house" training sessions or statewide conferences including review of the Crime Victims' Act and the Rules and Regulations governing the Act, review claims forms and procedures on how to file a claim with the Program. Provide information to co-workers regarding changes in statute, regulations, or policies. Assist the Direct Victims' Services Coordinator, as requested, with consultative sessions which are in-person meetings with victims/claimants conducted in a supportive atmosphere designed to provide an opportunity for them to address their questions and concerns regarding claim denials or disputed awards. Upon request, represent the Program at meetings and conferences. As requested, assist the Claims Review Unit Supervisor or VCAP Manager with a variety of special projects as assigned by the Claims Review Unit Supervisor and/or VCAP Program Manager. Travel may be required on short notice. Performs other duties as required. |
Decision Making: Describe the types of decisions made by the incumbent of this position and the types of decisions referred to others. Identify the problems or issues that can be resolved at the level of this position, versus those that must be referred to the supervisor. Example: In response to a customer inquiry, this work involves researching the status of an activity and preparing a formal response for the supervisor’s signature. Review claims where contribution or denial may be warranted and either make a recommendation to deny, reduce or pay the claim, consistent with the governing law and Rules and Regulations. Recommendations may be forwarded to the supervisor for review when the contribution or denial is not obvious based on information received from law enforcement. Prepares statutory denials, award reconsiderations and award reaffirmations based on documentation received from the claimant and others as needed to effectuate decisions on claims with consultation from a supervisor. Reviews and determines eligibility for new claims received by applying the Crime Victim's Act, the Rules and Regulations governing the Program, and the Program's processing guidelines with involvement from supervisors, benefit trainers and/or 2nd approvers. Determines eligibility by conducting a comprehensive review of the police report to determine if a Claims Review Unit decision is required for contribution assessment or denial. Prepares the Review and Determination ensuring accuracy and completeness of information entered into the DAVE system and accuracy of award calculations. |
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Requirements Profile: Identify any specific experience or requirements, such as a licensure, registration, or certification, which may be necessary to perform the functions of the position. Position-specific requirements should be consistent with a Special Requirement or other criteria identified in the classification specification covering this position. Example: Experience using Java; Professional Engineer License Experience: Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. 5. 6. |
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Essential Functions: Provide a list of essential functions for this position. Example: Transports boxes weighing up to 60 pounds.
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