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Commonwealth of Pennsylvania |
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POSITION DESCRIPTION FOR JOB POSTING |
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Position Number: 50534989 |
Description Activated On: 9/16/2025 8:46:50 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 work-related injury claims where only first aid was administered (incident only claims) or where only limited medical treatment was needed and no time was missed from work, other than for medical appointments (medical only, no lost time claims) and provides support to the WRIS. |
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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; claims investigation; injury leave processing; Commonwealth Management Directives and Manuals; collective bargaining agreements; 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. Provides guidance on routine questions related to injury management and leave, and how to enter claims to SAP. Activates prescription cards and prepares managed care cards. CLAIMS MANAGEMENT: Upon assignment of new claims from the center supervisor, reviews and investigates the claims by talking with the supervisor and employee, and occasionally witnesses and safety investigators. If it is unclear that employees have or will see a health care provider, adjusts SAP to an incident only claim if the investigation cannot be done on the day that claims are received to avoid the medical claim administration fee. Ensures that all information within the injury packet is received and follows-up as needed with supervisors when it is not. Provides verbal and written information to employees and supervisors about the compensation and medical treatment for workers’ compensation and leave should any time off be necessary in the future. 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 for medical only, no time lost claims. Prepares template letters, and updates the workers' compensation tracking system with actions taken on claims to ensure thorough record keeping. When it is learned during claims investigations that employees are or will be absent from work for the injury or the employee is able to work with restrictions, reassigns the claim to the appropriate next level specialist for continued claim management. Notifies the center 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. Assists the litigation analyst to prepare for litigation on cases previously handled. Provides testimony at hearings when requested. OTHER: Responsible for compiling and sending the monthly reports to agencies serviced by WRIS by the 7th of each month. Serves as back-up for answering the main WRIS telephone, answering basic questions, forwarding to the appropriate person, or taking messages. Reviews leave entries for new injuries reported to the team to ensure that all newly injured employees are recording absences. Serves as back-up support person for team members by answering telephone calls, distributing paper and electronic mail, sending mail, and other administrative tasks. 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. Incumbent uses knowledge and methods for gathering information and analyzing situations. On matters beyond the individual’s position, seeks further direction from the supervisor or requests case be reassigned. |
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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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