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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 00155037 |
Description Activated On: 1/16/2026 9:19:51 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. Provides quality customer service to incoming phone callers for all aspects of the State Workers’ Insurance Fund (SWIF) operations. Acts as the first point of contact for SWIF and provides support for the organization within all SWIF departments and offices. |
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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. Serves as first point of contact for SWIF external customers for all aspects of SWIF operations, including applications and renewals, insurance policy terms and rates, auditing and underwriting, claims, medical bills, accounting and invoicing, and injury reporting. Interacts with adjustors, employers, policyholders and injured workers. Answers complex questions from callers relative to all phases of SWIF operations and functions. Resolves customer questions and concerns in a professional and courteous manner. Accesses various software applications and screens through SWIF’s information systems to locate account information in order to answer questions and identify potential resolutions and corrective actions. If necessary, contacts SWIF operations staff or the third-party administrator to obtain information and contacts the customer via phone or email to relay additional information or resolve the issue. Receives calls regarding first reports of workplace injuries, asking callers for information needed to complete questionnaires; enters responses into the information system to initiate the claim review process. Answers caller questions regarding SWIF policies, processes, and requirements. Answers customer questions related to invoices, fees, and rate changes. Receives and processes calls regarding changes in a claim’s status and notifies the assigned claims adjuster about changes. Assists policyholders and applicants with estimating premium rates using SWIF’s premium rate worksheet. Assists callers with determining whether claims or medical bills have been paid or denied in compliance with the Bureau’s policies and applicable regulations. Makes decisions in the best interest of SWIF and its customers; communicates any necessary tasks with supervisors/managers of operations units. Maintains knowledge of SWIF’s operations, workers’ compensation insurance, medical terminology, and applicable regulations as set by the Pennsylvania Compensation Rating Bureau and Bureau of Workers’ Compensation. Answers incoming phone calls from SWIF policyholders and agents regarding work-related injuries; enters the injury report into SWIF’s information system in an expeditiously, accurately and concisely. Inputs changes of status reports from policyholders and their agents and notifies proper District Office personnel of the change of status. Retrieves phone messages on the 800 Unit voice-messaging system in a timely fashion and contacts the policyholders regarding action steps. Creates, maintains and submits to supervisor and/or manager logs of all processed calls for the Customer Service Unit and First Reports of Injury. Identifies areas in customer service, workflow or process improvements through customer interaction and works with supervisors/managers to see that they are addressed. Performs other related duties 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. Uses knowledge of SWIF’s operations, policies, regulations, and procedures to make decisions regarding a wide variety of potential situations, such as: a) what forms and what funds are needed to apply for a policy b) what the customer needs to reinstate a policy c) whether or not a workers compensation policy is needed d) what stage a medical bill for a claim is in and what is still needed for it to be paid e) if a medical bill was paid/denied correctly f) what is needed for the purpose of an audit or re-audit. g) if a credit refund is eligible for a return to a client or if additional information is needed. h) if an injury is valid and reportable i) The severity of a work-place injury The employee is expected to resolve issues independently using their best judgment to balance the business needs of SWIF with customer satisfaction, taking into consideration the appropriate SWIF policies and regulations, the history of the account, the precedent of similar issues, and the financial risks or benefits to the organization. |
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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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