State of Maryland

The Claims Reviewer Advanced is the advanced level of processing workers’ compensation claims. Employees in this classification interpret and process complex workers’ compensation claims and hearing related documents. Employees in this classification do not supervise other positions, but train new and existing employees in the agency and may assist with training other interested parties in the workers’ compensation community.

Employees in this classification receive general supervision from a Claims Reviewer Supervisor or higher-level Administrator.

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 Advanced is differentiated from the Claims Reviewer II in that the Claims Reviewer Advanced interprets and processes complex workers’ compensations claims and hearing related documents, trains and develops new and existing employees, and may assist with training other interested parties in the workers’ compensation community, while the Claims Reviewer II performs the full range of duties under general supervision. The Claims Reviewer Supervisor is differentiated from the Claims Reviewer Advanced in that the Claims Reviewer Supervisor has supervisory responsibility for lower-level Claims Reviewers.

Interprets and processes complex workers’ compensation claims and hearing related documents;

Reviews claims for completeness, accuracy and compliance based on agency regulations and laws as noted int COMAR;

Determines whether claims may be compensated or deferred for a hearing or held pending the receipt of additional information, including, and limited to insurance coverage validations;

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 to process claims in a timely manner;

Rescinds orders, withdraws claims and amends awards as appropriate;

Explains workers' compensation laws and procedures to claimants, employers, insurers, members of the legal and medical professions, new and existing employees in the agency and other interested parties;

Trains new and existing employees in the agency; and may assist with training other interested parties in the workers’ compensation community;

Monitors progress and development of trainees;

Creates and develops training status reports to track progress of trainings and presenting them to management;

Performs other related duties.

Knowledge of workers' compensation laws;

Knowledge of general business practices;

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

Ability to evaluate factual information, identify issues and problems, and initiate appropriate corrective action used in processing claims and other claim/hearing related documents;

Ability to learn and train others on existing and new procedures, processes and systems;

Ability to create and manage reports with complex information;

Ability to communicate effectively.

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

Experience: Two years of experience in processing workers’ compensation claims.

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.