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Workers' Compensation Claims Examiner

Department of Labor
Office of Workers' Compensation Programs
Coal Mine Workers' Compensation; Energy Employees Occupational Illness Compensation
This job announcement has closed

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.

The positions are inside the bargaining unit.

Selections can be made at any advertised grade(s).

Additional selections may be made from this announcement.

Overview

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Hiring complete
Open & closing dates
08/16/2023 to 08/29/2023
Salary
$46,696 - $111,157 per year
Pay scale & grade
GS 7 - 11
Location
Many vacancies in the following location:
Anywhere in the U.S. (remote job)
Remote job
Yes
Telework eligible
Not applicable, this is a remote position.
Travel Required
Not required
Relocation expenses reimbursed
No
Appointment type
Permanent
Work schedule
Full-time
Service
Competitive
Promotion potential
12
Supervisory status
No
Security clearance
Not Required
Drug test
No
Position sensitivity and risk
Moderate Risk (MR)
Trust determination process
Announcement number
MS-23-PHIL-OWCP-12081421-LS
Control number
743579300

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Duties

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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

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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 alone 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.
Or

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.

Additional information

This position is inside the bargaining unit. If the duty location is within the Washington, D.C. metropolitan area, the position will be included in the Local 12, AFGE bargaining unit. If the duty location is outside the Washington, D.C. metropolitan area, the position will be included in the NCFLL bargaining unit.

Persons who are deaf, hard of hearing, blind, or have speech disabilities, please dial 711 to access telecommunications relay services.

The mission of the Department of Labor (DOL) is to protect the welfare of workers and job seekers, improve working conditions, expand high-quality employment opportunities, and assure work-related benefits and rights for all workers. As such, the Department is committed to fostering a workplace and workforce that promote equal employment opportunity, reflects the diversity of the people we seek to serve, and models a culture of respect, equity, inclusion, and accessibility where every employee feels heard, supported, and empowered.

Refer to these links for more information: GENERAL INFORMATION, REASONABLE ACCOMMODATION, ADDITIONAL DOCUMENTATION, FORMER FEDERAL EMPLOYEES

The full promotion potential is GS-12.There is no obligation to provide future promotions if you are selected. Promotions are dependent on your ability to perform the duties at a higher level, meet all the performance requirements, and the supervisor's recommendation to the next grade.

How you will be evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Evaluation Factors (Competencies) - All qualified applicants will be evaluated on the following key competencies:

  • Customer Service
  • Decision Making
  • Legal, Government and Jurisprudence
  • Oral Communication
  • Technical Competence
  • Writing

Click here for Evaluation details.

You may preview questions for this vacancy here: https://apply.usastaffing.gov/ViewQuestionnaire/12081421

The information you provide may be verified by a review of your paid, unpaid, volunteer, and other lived experience, as it demonstrates the competencies or skills required for the position to be filled. Your evaluation may include an interview, reference checks, or other assessment conducted by HR specialists, subject matter experts, or panel members and may include other assessment tools (ex. interview, structured interview, written test, work sample, etc.). The examining Office of Human Resources (OHR) makes the final determination concerning applicant ratings. Your resume MUST provide sufficient information to substantiate your vacancy question responses. If not, the OHR may amend your responses to more accurately reflect the level of competency indicated by the content of your resume.

INFORMATION FOR ICTAP/CTAP ELIGIBLE(S) ONLY: If you are eligible for special priority selection under ICTAP/CTAP, you must be well-qualified for the position to receive consideration. ICTAP/CTAP eligible(s) will be considered "well-qualified" if they attain at least a rating score of 85 in a numerical rating scheme. Be sure to review the eligibility questions to reflect that you are applying as an ICTAP or CTAP eligible and submit supporting documentation.

Office of Workers' Compensation Programs

Agency contact information

Linda Stowell
Phone
215-861-5032
Email
stowell.linda.m@dol.gov
Address
Office of Workers Compensation Programs
200 Constitution Avenue NW
Washington, DC 20210
US

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Learn more about what it's like to work at Office of Workers' Compensation Programs, what the agency does, and about the types of careers this agency offers.

https://www.dol.gov/general/jobs/vacancy-information#marketing-statement

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