State of Maryland

A Claims Reviewer I is the intermediate level of work processing workers' compensation claims.  Employees in this classification do not supervise other positions.

Employees in this classification receive moderate supervision from a Claims Reviewer Supervisor.

Positions in this classification are evaluated using the classification job evaluation methodology.  The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of the class specification.

The Claims Reviewer I and Claims Reviewer II are differentiated on the basis of the degree of supervisory control exercised by the supervisor over these employees.  The Claims Reviewer I performs duties under close supervision at times and under general supervision at other times depending upon the complexity of the specific duty being performed.  The Claims Reviewer II performs the full range of duties and responsibilities under general supervision.

Receives and codes workers' compensation claims and related case documents;

Reviews claims for completeness, accuracy and compliance with agency regulations and procedures;

Applies workers' compensation laws, rules and established guidelines to determine whether claims may be compensated or deferred for a hearing or held pending the receipt of additional information;

Contacts claimants, employers, insurers, attorneys and other members of the compensation community to obtain and clarify pertinent information;

Computes award benefit amounts using earnings records and established guidelines;

Determines and initiates actions including continuances and pleadings of other parties in order to process claims in a timely manner;

Resolves complaints and prepares correspondence and reports on workers’ compensation claims;

Explains workers’ compensation laws and procedures to claimants, employers, insurers, members of the legal and medical professions, and other interested parties;

May rescind orders, withdraw claims and amend awards as directed;

May assist claimants in filing a claim;

Performs other related duties.

Knowledge of general business practices;

Ability to learn, understand, interpret, apply and explain workers' compensation laws, rules, procedures and practices;

Ability to evaluate factual information, identify incomplete claims, and initiate appropriate corrective action according to established guidelines;

Ability to communicate effectively.

Education: Graduation from an accredited high school or possession of a high school equivalency certificate.

Experience: One year of clerical experience handling compensation claims or three years of general clerical experience.

Notes:

1. Candidates may substitute additional general clerical experience on a year-for-year basis for the required education.

2. Candidates may substitute U.S. Armed Forces military service experience as a non-commissioned officer in Workers’ Compensation Claims Examining classifications or Workers’ Compensation Claims Examining specialty codes in the Legal and Kindred field of work on a year-for-year basis for the required experience. 

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies. Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System. All positions in this classification are Skilled Service positions. Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is assigned to Bargaining Unit B, Administrative, Technical and Clerical classes. As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial, and confidential employees are excluded from collective bargaining. Additionally, certain executive branch agencies are exempt from collective bargaining and all positions in those agencies are excluded from collective bargaining.

Employees in this classification are eligible to receive overtime compensation. An employee who works more than the normal workweek is entitled to be compensated for that overtime as provided by State Personnel and Pensions Article, Section 8-305.

This classification is one level in a Non-Competitive Promotion (NCP) series. NCP promotions are promotions by which employees may advance in grade and class level from trainee to full performance level in a classification series. In order to be non-competitively promoted to the next level in a NCP series an employee must: 1) perform the main purpose of the class as defined in the Nature of Work section of the class specification; 2) receive the type of supervision defined in the class specification and 3) meet the minimum qualifications of the classification.