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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 50428180 |
Description Activated On: 7/21/2025 8:10:02 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. Working within the HR Service Center, the employee is a team member of the Work-Related Injury Services (WRIS). The incumbent manages medical w/lost time claims, modified duty and indemnity claims for a specified period of time. |
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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. General In the performance of all job duties, maintains and uses knowledge of the Workers’ Compensation Act and special benefits programs, which includes: compliance with the PA Workers’ Compensation Act, PA Act 632/534, PA Heart & Lung Act and their related regulations and case laws; claims investigation; injury leave processing; transitional duty assignment; Commonwealth Management Directives and Manuals; collective bargaining agreements and past practices; the Accident and Illness Prevention Program (AIPP); the Personnel Rules; and agency specific policies related to injuries and illnesses at work. Maintains a general understanding of the policy and programs for the State Employee Assistance Program (SEAP), AIPP, Family and Medical Leave Act (FMLA), and Americans with Disabilities Act (ADA), and other human resource laws and programs that sometimes have a nexus to work-related injuries. Works with the contracted workers’ compensation third party administrator (TPA) and Bureau of Commonwealth Payroll Operations (BCPO) to ensure employees receive appropriate pay and benefits. Claims Management Upon assignment of new claims from the team supervisor, reviews and investigates the claims by talking with the supervisor and employee, and occasionally witnesses and safety investigators. Provides verbal and written information to employees and supervisors about the compensation and medical treatment for workers’ compensation, Act 632/534 or Heart & Lung benefits if applicable, possible overpayments, leave, and return to work options. Based on the results of the investigation, if necessary, makes adjustments to claims information and provides additional information obtained through the investigation to the TPA. As necessary, provides the TPA with change of status claim information. Works closely with the TPA to develop case strategies for returning employees to work or closing claims. Approves field case management as needed to obtain additional information to evaluate return to work. Notifies the team supervisor and TPA of complaints/concerns about panel doctors for further investigation. Complaints/concern could include timeliness of appointments, lack of regard to return to work options, or bedside manner with the employee/patient. Ensures leave is entered for all absences, including medical appointments. Approves or rejects workflow requests for injury/illness related leave, after carefully reviewing documentation provided and the claim status to determine eligibility. Completes absence entries and long-term LWOP or injury or special benefits leave actions in SAP and requests HRSC center assistance for complex actions as needed. In cooperation with the agency, pursues return to work options for injured employees based on restrictions provided by the health care provider and work tasks of employees’ positions. Sets tasks and manages cases until the employee malingers longer than the timeframes established by medical guidelines, has other medical conditions preventing the employees’ return to work, is litigated, or the claim has been open for six months. Assists the litigation analyst to prepare for litigation on cases previously handled. Provides testimony at hearings when requested. Reviews inquiries from BCPO concerning leave entries, workers’ compensation payments, and pay discrepancies. Resolves injury leave and pay problems by researching SAP, researching the TPAs online claims system, contacting TPA claims adjusters, supervisors, or other liaisons. Provides information to the team supervisor to respond to inquiries from employees, supervisors or employees’ attorneys about overpayments. Prepares template letters, and updates the workers' compensation tracking system with actions taken on claims to ensure thorough record keeping. Performs special projects and other duties as required or 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. Routine work is completed independent of others. The supervisor routinely reviews work for quality, timeliness, consistency and accuracy. On complex or unusual matters, the incumbent discusses the issue with the supervisor and makes a recommendation before taking action. |
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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. 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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