DEPARTMENT OF MANAGEMENT SERVICES
For Reference Only
CLASS CODE: 3313
PAY GRADE: 016
CLASS TITLE: SENIOR WORKERS' COMPENSATION EXAMINER
ALLOCATION FACTOR(S)
This is professional work analyzing workers' compensation insurance policies, injured worker cases,
and various case management systems; processing workers' compensation fund receipts, invoices and
initial claim disbursements/reimbursements for workers' compensation; or assisting with
certification/approval of parties involved with and regulated by the workers' compensation program.
EXAMPLES OF WORK PERFORMED:
(Note: The examples of work as listed in this class specification are not necessarily descriptive of any
one position in the class. The omission of specific statements does not preclude management from
assigning specific duties not listed herein if such duties are a logical assignment to the position.
Examples of work performed are not to be used for allocation purposes.)
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Examines and analyzes compensable and/or employers' case files to ensure the accuracy of the
data reflected in the case or file, employers' files or enforcement files, and assists in monitoring
policies and procedures used by bureaus as they pertain to case files to ensure proper
compliance with those procedures and policies.
Identifies problems or potential problems involved in the processing of injured worker case
files, compliance or legal files and presents solutions to management for review.
Prepares required reports from tabulated claims information and/or employers' files and
reviews the accuracy of tabulated machine work.
Prepares and maintains statistical records regarding training, education and peer review
program.
Coordinates peer review process; advises of peer review activities; examines trends of service
providers.
Prepares summary reports of opinions and recommendations submitted by division staff and
other consultants.
Contacts insurance companies, employers, employees, Judges of Compensation Claims,
physicians, attorneys and other interested parties to obtain facts relating to workers'
compensation files.
Investigates, when they become final, Orders of Judges of Compensation Claims, District Court
of Appeals and State Supreme Court; takes action to assure carrier/employer compliance with
3313-SENIOR WORKERS' COMPENSATION EXAMINER-CS
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the Order, if necessary by filing a Rule Nisi with the appropriate circuit court and certification to
Insurance Commissioner.
Analyzes claims documents for late payment and/or reporting; determines the party at fault
when violations occur; determines and calculates the fine and penalty to be assessed; and
issues Administrative Orders for compliance with assessment.
Analyzes and interprets Judges' Orders; calculates monetary awards and/or reimbursement to
the Workers' Compensation Administrative Trust Fund.
Coordinates the processing of cash receipts for workers' compensation administration and
special disability assessments.
Reviews, interprets, and analyzes workers' compensation correspondence and information to
determine compliance with workers' compensation laws, rules and procedures.
Examines pre-screening documents to determine eligibility of injured employee for
reemployment services.
Reviews current payment tracking system for improvement of customer service delivery.
Coordinates payments of workers' compensation supplemental permanent total benefits.
Performs other related work as required.
KNOWLEDGE, SKILLS AND ABILITIES:
(Note: The knowledge, skills and abilities (KSA's) identified in this class specification represent those
needed to perform the duties of this class. Additional knowledge, skills and abilities may be applicable
for individual positions in the employing agency.)
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Knowledge of the principles and techniques of effective communication.
Knowledge of basic arithmetic.
Ability to examine and evaluate data relating to a workers' compensation program.
Ability to understand and apply applicable rules, regulations, policies and procedures relating to
a workers' compensation program.
Ability to handle telephone calls in a fast, courteous and effective manner.
Ability to deal with the public in a tactful and courteous manner.
Ability to work independently.
Ability to utilize problem-solving techniques.
Ability to plan, organize and coordinate work assignments.
Ability to conduct fact-finding investigations.
Ability to communicate effectively.
Ability to establish and maintain effective working relationships with others.
Ability to prepare and maintain reports.
Ability to perform basic arithmetical calculations.
MINIMUM QUALIFICATIONS
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A bachelor's degree from an accredited college or university and one year of professional
experience in workers' compensation, counseling, interviewing, administrative work or an
insurance adjusting, examining, investigating or claims processing program; or
One year of professional experience in a workers' compensation program.
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A master's degree from an accredited college or university in insurance, business, public
administration or one of the social or behavioral sciences can substitute for the required
experience.
Professional or nonprofessional experience as described above can substitute on a year-foryear basis for the required college education.
EFFECTIVE:
6/24/1994
HISTORY: