State Workers' Insurance Fund Claims Adjuster Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4833913) Apply  State Workers' Insurance Fund Claims Adjuster Salary $50,836.00 - $77,321.00 Annually Location Lackawanna County, PA Job Type Non-Civil Service Permanent Full-time Job Number N-2025-19021 Department Department of Labor & Industry Division LI SWIF Wilkes-Barre & Scranto Opening Date 02/21/2025 Closing Date 3/2/2025 11:59 PM Eastern Job Code 70351 Position Number 00064151 Union AFSCME Bargaining Unit G1 Pay Group ST06 Bureau / Division Code 00121648 Bureau / Division SWIF Wilkes-Barre & Scranton District Office Worksite Address Scranton State Office Building Worksite Address 100 Lackawanna Avenue City Scranton, Pennsylvania Zip Code 18503 Contact Name Felicia Newbury Contact Email fnewbury@pa.gov + Description + Benefits + Questions THE POSITION The Department of Labor & Industry, State Workers’ Insurance Fund (SWIF) is seeking an individual with exceptional analytical and attention to detail skills as a SWIF Insurance Fund Claims Adjustor. In this role, you will have the opportunity to investigate, process, and manage reported work-related claims and injuries for employees of policy holders for the purpose of determining compensability. Apply today and become a part of our dedicated and valued team! DESCRIPTION OF WORK As a SWIF Claims Adjuster, you will be responsible for ongoing monitoring and controlling all aspects of the claim to conclusion in accordance with established procedures. Your time management skills will be key as you complete investigation for reported incidents or claims within 48 hours of receipt of the claim assignment and processes acceptance or denial within the time frame as prescribed by law. You will make determinations relating to pre-existing conditions, potential fraud, and return to work plans. Intake data must be complete, accurate, and included in claim files. You may be required to contact appropriate parties related to the reported claim including claimant, employers, doctors, hospitals, and witnesses to determine eligibility for workers’ compensation benefits. Other duties to include but not limited to: + Managing and monitoring claims on a continual basis to resolve ongoing exposures + Recognizing the need for filing of Utilization Review and referring to medical staff for review + Creating fact-based claim reserves within authority level with proper file documentation Interested in learning more? Additional details regarding this position can be found in the position description . Work Schedule and Additional Information: + Full-time employment. + Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch. + Telework: You may have the opportunity to work from home (telework) part-time. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Scranton. + Salary: In some cases, the starting salary may be non-negotiable. + You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices. REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY QUALIFICATIONS Minimum Experience and Training Requirements: + One year of experience as a SWIF Claims Representative (commonwealth title);or + One year of technical work in the processing, review, investigation, and payment of workers’ compensation insurance claims in the insurance industry;or + An equivalent combination of experience and training. Additional Requirements: + You must demonstrate the ability to adhere to the values and ethics of the Department of Labor & Industry. + You must demonstrate the ability to work with professionalism, discretion, and good work ethic. + You must possess solid written and verbal communication skills. + You must demonstrate initiative and problem-solving skills. + You must have at least five years of experience with the following Social Security Administration duties: + Process of appeals + Paybacks and overpayments + Identification of fraud + ORM enrollment and termination + Part A and B of Medicare + You must be able to perform essential job functions. Commonwealth employees who wish to use their seniority rightsmustapply to the internal posting for their seniority rights to be considered. How to Apply: + Resumes, cover letters, and similar documents willnotbe reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education). + If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable. + Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted. + Failure to comply with the above application requirements may eliminate you from consideration for this position. Veterans: + Pennsylvania law (51 Pa. C.S. §7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans’ Preference tab or contact us at ra-cs-vetpreference@pa.gov . Telecommunications Relay Service (TRS): + 711 (hearing and speech disabilities or other individuals). If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date. The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply. Learn more about our Total Rewards by watching this shortvideo (https://www.youtube.com/embed/HtcSRnndflc?rel=0) ! See the total value of your benefits package by exploring ourbenefits calculator. Health & Wellness We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.* Compensation & Financial Planning We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options. Work/Life Balance We know there’s more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.* Values and Culture We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving. Employee Perks Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships. For more information on all of these Total Rewards benefits, please visitwww.employment.pa.gov and click on the benefits box. *Eligibility rules apply. 01 Have you been employed by the Commonwealth of Pennsylvania as a SWIF Claims Representative for one or more years full-time? + Yes + No 02 If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experiencemustalso be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below. 03 How much full-time technical experience do you possess in the processing, review, investigation, and payment of workers' compensation insurance claims in the insurance industry? + 1 year or more + Less than 1 year + None 04 If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experiencemustalso be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below. 05 How many semester credits of college coursework do you possess in any field of business? If you are claiming credits/degree, you must upload a copy of your college transcript(s) for this education to be considered in the eligibility decision. Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a transcript(s) to the application after it has been submitted. If your education was acquired outside of the United States, you must upload a copy of your foreign credential evaluation report. We can only accept foreign credential evaluations from organizations that are members of the National Association of Credential Services (NACES). A list of current NACES members can be found by visitingwww.naces.organd clicking the Evaluation Services Link. For additional information on foreign education credentials, please visithttps://www.employment.pa.gov/Additional%20Info/Pages/default.aspx#q3and click on Other Information. You must attach your documentation prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a document to the application after it has been submitted. + 30 credits or more + Less than 30 credits + None 06 Additional Requirement- Do you have at least five years of experience with the following Social Security Administration duties? · Process of appeals · Paybacks and overpayments · Identification of fraud · ORM enrollment and termination · Part A and B of Medicare + Yes + No 07 If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experiencemustalso be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below. Required Question Employer Commonwealth of Pennsylvania Address 613 North Street Harrisburg, Pennsylvania, 17120 Website http://www.employment.pa.gov