Job Details
Workers' Compensation Claims Examiner (REMOTE)
Summary
The positions are located in the Department of Labor, (DOL) Office of Workers' Compensation Programs (OWCP), Division of Coal Mine Workers' Compensation (DCMWC) and Division of Energy Employees Occupational Illness Compensation (DEEOIC). Three positions will be filled in DCMWC and five positions in DEEOIC.
Location
Many vacancies in the following location:
Anywhere in the U.S. (remote job)
The positions are inside the bargaining unit.
Selections can be made at any advertised grade(s).
Additional selections may be made from this announcement.
Clarification from the agency
Open to current and former permanent competitive service employees and those eligible for Schedule A, former Peace Corps and VISTA volunteers, Land & Base Management, VRA, VEOA, Disabled Veteran, and military spouse authorities. Also advertised under Job Announcement Number DE-23-PHIL-OWCP-12081419-KG for all U.S. citizens. To be considered for each, apply to BOTH announcements.
Duties
Salary posted reflects nationwide locality pay range. Once the selection has been made, the salary will be set per the selectee's home worksite.
The OWCP mission is to protect the interests of workers who are injured or become ill on the job or as a result of employment, their families, and their employers by making timely, appropriate, and accurate decisions on claims, providing prompt payment of benefits, and helping injured workers return to gainful work as early as is feasible.
Major duties of this position include:
- Conducts fact-finding to properly gather, assess, analyze and adjudicate a broad range of disabling occupational diseases and illnesses, and death claims assigned.
- Develops and makes determinations on the proper disposition of claims for assigned cases.
- Reviews and adjudicates claims to make determinations on entitlement to benefits and medical issues for which there are established precedents or where factual and medical opinion clearly supports the claim.
- Examines medical, employment, and other factual evidence for claims for benefits involving work-place illnesses for factual sufficiency and legal correctness to determine if the compensation claim and/or medical benefit claim meets the criteria outlined in established policies, procedures, or other guidelines.
- Employs standard investigative approaches to obtain information, evidence, and other documentation related to claims.
- Reviews and evaluates a variety of evidentiary documents (e.g., narrative medical reports commenting upon the relationships of the disability to the implicated employment factors, history of claimant's disability and health history, specifics of employment felt to be the cause of injury, job descriptions, workplace exposures, comments on the veracity of the claimant's statements, employment records, letters or certificates of medical necessity, etc.) from a variety of sources submitted with or subsequent to the initial claim.
- Prepares correspondence and maintains working relationships with claimants, employers, physicians, medical providers, representatives, attorneys, and other sources to obtain missing or supplemental medical and employment documents, to clarify information, and to secure additional factual and medical information needed to adjudicate the claim.
- Prepares statements of accepted facts and refers cases for medical opinion to the program medical advisor/consultant for second opinions, independent medical examinations and/or case reviews that may or may not require a claimant to undergo a physical examination, to clarify medical opinions or to resolve conflicts in medical opinion.
- Makes recommended determinations on claims ensuring that decisions are consistent with established guidelines.
- Processes payments of compensation and impairment awards in accordance with the appropriate program procedural manual.
- Provides technical assistance and advice to claimants and/or their representatives on eligibility for benefits.
*At the GS-07 and GS-09 grade levels, assignments are developmental; as the incumbent progresses, the assignments become more difficult and complex at the GS-11 and GS-12 full journeyman.
Requirements
Conditions of Employment
- Must be at least 16 years old.
- Must be a U.S. Citizen.
- Candidate required to obtain the necessary security/investigation level.
- Requires a probationary period if the requirement has not been met.
Qualifications
In describing your experience, please be clear and specific. Position titles along cannot be used to determine if you are qualified. Please list dates in MM/DD/YYYY format. This is imperative in determining if you have at least one year of creditable specialized experience. Dates will not be assumed.
GS-07: Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-05, in the Federal Service.
Qualifying specialized experience must include three of the following:
- Receiving and evaluating forms and supporting evidence for completeness.
- Experience with medical terms and findings and causes of diseases.
- Writing correspondence of a business nature to internal and external customers seeking information and/or recommendations or decisions.
- Communicating with customers, representing the organization to customers and others in person, by phone, or in writing.
Have one full year of graduate level education, or Superior Academic Achievement,
Or
A combination of graduate education and experience.
GS-09: Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-07, in the Federal Service.
Qualifying specialized experience must include three of the following:
- Receiving and evaluating forms and supporting evidence for completeness and development of benefit claims.
- Experience with medical terms and findings, causes of diseases, treatment methods and probable results and relationship to occupation.
- Writing correspondence of a business nature to internal and external customers seeking information and/or recommendations or decisions.
- Representing an organization to provide advice or guidance on technical or complex issues to customers.
Or
Have earned a Master's or equivalent graduate degree, or completed 2 full years of progressively higher-level graduate education leading to such a degree, or LL.B. or J.D., if related,
Or
A combination of graduate education and experience.
GS-11: Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-09, in the Federal Service.
Qualifying specialized experience must include three of the following:
- Developing, examining, adjudicating, and authorizing claims with highly complex medical and factual issues.
- Making determinations on medical issues and employment evidence.
- Preparing written documents seeking information and/or recommendations or decisions based on research and evidence.
- Representing an organization to provide advice or guidance on technical or complex issues to customers.
Or
Ph.D. or equivalent doctoral degree, or 3 full years of progressively higher level graduate education leading to such a degree, or LL.M., if related,
Or
A combination of graduate education and experience.
Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level.
Education
Any applicant falsely claiming an academic degree from an accredited school will be subject to actions ranging from disqualification from federal employment to removal from federal service.
If your education was completed at a foreign college or university, you must show comparability to education received in accredited educational institutions in the United States and comparability to applicable minimum coursework requirements for this position. Click Evaluation of Foreign Education for more information.