Claims Examiner
Claims Examiner
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Job Description
Title: Claims Examiner
State Role Title:Salary Non-Specified
Hiring Range: Minimum starting salary $47003 commensurate with experience.
Pay Band: UG
Agency: VA Workers Compensation Comm
Location:RICHMOND HEADQUARTERS
Agency Website: Type: Agency Employee Only - A
This position is open to agency only employees. Candidates must be currently employed by Virginia Workers Compensation Commission to be considered.
Do you wonder who processes the thousands of claims VVF receives from victims of crime The Fund has a team of claims examiners who review police reports medical records billing statements and receipts and determine which expenses are eligible for reimbursement.
This claims examiner position is not for the faint of heart - you must thrive handling a voluminous case load utilize critical thinking skills and stay positive when speaking with frustrated callers. On a brighter note you will feel appreciated and supported by an engaging team you will enjoy a healthy work life balance in a telework environment and you will feel a deep sense of pride in your work. If youre still reading and are interested this may be the perfect opportunity for you!
Job Duties
Virginia Workers Compensation Commission administers the Virginia Compensating Victims of Crime Act through the Criminal Injuries Compensation Fund also known as the Virginia Victims Fund (VVF). The Criminal Injuries Compensation Fund helps victims of violent crime with out-of-pocket expenses including medical bills prescriptions funeral expenses and many other expenses. While money can never erase the scars and painful memories of a crime our programs may ease some of the financial burdens faced by victims and their families.
The Criminal Injuries Compensation Fund is seeking a highly qualified energetic team player to fill one Claims Examiner positions. This position will initiate the claims process review files for accuracy and completeness make follow-up requests as needed and examine documentation that supports the basis of the claim in order to determine eligibility. This position also examine circumstances of crime to determine eligibility determine amount of awards analyze collateral resources apportion reduce or compromise if necessary and make claim determinations based upon documentation and information received from claimant and stakeholders. Additional responsibilities include answering inquiries and corresponding with clients and allied professionals via phone or in person; corresponding and collaborating with stakeholders to promote and enhance the claims process; and supporting training and outreach. This position may also help manage VVFs grants. Must past criminal background check as a condition of employment.
VWC Compensation Structure
Virginia Workers Compensation Commission is an independent agency which allows us to have a more competitive and unique pay structure. This position is a pay grade 5 based on a 14 grade pay structure. Our positions are not classified under DHRMs pay bands.
Telework Structure
Our agency is currently using a hybrid model for teleworking. Our positions at this time are not 100% teleworking. All candidates would be expected to report to our Headquarters/Regional Office as requested. Telework scheduling is at the discretion of the Manager based on the business needs of the department. Upon hire candidates should expect to have all training and orientation conducted at the Headquarters Office.
Virginia Workers Compensation Commission Overview
Led by a Senior Leadership team consisting of three Commissioners an Executive Director and a Chief Deputy Commissioner. Our mission is to serve injured workers victims of crimes employers and related industries by providing exceptional services resolving disputes and faithfully executing the duties entrusted to us by the Commonwealth of Virginia. Our vision is to lead the nation as the most effective and innovative state agency. VWC employees demonstrate seven core values: innovation respect accountability reliability impartiality integrity and effectiveness.
We are a Virginia Values Veterans (V3) official certified state agency that supports Veterans and Members of the Reserves and/or National Guard. If you are a Veteran or Spouse of a Veteran or Active Military Member we urge you to respond accordingly on your state application. Virginia Workers Compensation Commission is an Equal Opportunity Employer and we encourage diversity within our workforce. Virginia Workers Compensation Commission does not provide sponsorship for employment.
VWC is the recipient of the following awards:
- 2022 - 2025 Top USA Workplace
- 2021 - 2025 Top Workplace Richmond Region
- 2023 - 2025 Top Award for Mid-Sized Companies
- 2022 - 2023 Doers Award
- 2024 Managers Award
- 2025 Leadership Award McGill
Minimum Qualifications
- Experience providing high-volume case management in a fast-paced criminal justice human services or related environment
- Experience with claims examination to include billing and payment determination
- Experience interacting with a diverse group of professionals and customers via verbal and written communication
- Experience gathering information and creating and presenting reports
- Working knowledge of victims issues and the resources available to victims; Virginias criminal justice system and/or criminal code
- Strong analytical and logical reasoning and administrative research skills and abilities
- Strong work ethic and attention to detail
- Demonstrated ability to exercise good judgment and work within deadlines in a high volume fast-paced environment
- Demonstrated ability to work both independently and as part of a team
- Ability to travel overnight on occasion
- Proficiency with Microsoft applications including Word Outlook Power Point and Excel; data entry and retrieval from computer databases such as CICF VEC and LOPAS; and Internet research principle
Additional Considerations
- Experience with claims examination case management victims compensation and/or the Code of Virginia sections applicable to CICF
- Working knowledge of the Code of Virginia sections relating to the Criminal Injuries Compensation Fund and medical billing processes and terminology
- Knowledge of federal grant processes to occasionally assist with managing VVF grants.
Special Instructions
You will be provided a confirmation of receipt when your application and/or rsum is submitted successfully. Please refer to Your Application in your account to check the status of your application for this position.
Contact Information
Name: Amy Habel
Phone:
Email:
In support of the Commonwealths commitment to inclusion we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS) or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation if applicable to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at .
Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1 2022- February 29 2024 can still use that COD as applicable documentation for the Alternative Hiring Process.
Employment Type
Full-Time
