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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00120102 |
Description Activated On: 7/28/2026 9:35:38 AM |
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 TPA Chief, assists as directed to ensure SWIF TPA services and requests are conducted efficiently and effectively. Responsible for entering, processing, and managing reported UEGF/SIGF 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. Enters new UEGF/SIGF Claim Petitions into SWIF’S computer system, assigns an adjuster and emails them the new claim information. Sends claim notice letters on all newly assigned claim within 7 business days of receipt of the assignment email. Sends LIBC forms on newly assigned claims, bi-annually, and upon receipt of a decision granting a UEGF/SIGF claim petition. Processes medical bill payments submitted on assigned claims, as well as monitors and manages the medical treatment. Sends denial letters for denied medical bills when appropriate. Processes claim payment vouchers as necessary and documents the claim file with reasons for payment. Updates SWIF’S computer system when hearing notices are received. Reviews medical only claims and completes status reports when appropriate. Reviews WCAIS Notes and completes all task assigned by the BWC. Recognizes the need for and recommends the use of Independent Medical Examination. Identifies and reports potential fraud situations to the TPA Services Units Fraud Officer and the TPA Chief. Contacts appropriate parties regarding the status of medical bill payments. Identifies and makes recommendation to the Medical Records Examiner Supervisor of suspected excess use of medical treatment. Maintain working knowledge of SWIF’s computer system and access required information, such as, verifying employer’s coverage, payment status of claims (indemnity and medical), claim numbers and other related fields as required. Performs related work as assigned. |
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. Enters, processes, and manages reported UEGF/SIGF Claims. |
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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: MINIMUM EXPERIENCE AND TRAINING: (NOTE: Based on the Entry Level Knowledges, Skills, and Abilities) • 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. Licenses, registrations, or certifications: 1. N/A 2. N/A 3. N/A 4. N/A 5. N/A 6. N/A |
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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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