Lead Workers Compensation Claims Examiner

Duties

• As Lead Claims Examiner (CE), help lower grade CEs determine the proper disposition of claims, and assist with the preparation of their recommended decisions. The adjudication process is complicated by issues related to jurisdiction, responsible employer, average weekly wages, the causal relationship of death or disabling condition to injury, wage-earning capacity, the nature and extent of disability, and insufficient or inconclusive medical opinions, which raises conflicts between medical opinions or between medical opinion and other evidence. Applies extensive knowledge of workers' compensation laws and legislation, case law, and precedents to assist lower-level CEs adjudicate cases.
• In instances that involve highly difficult medical questions or concerns, i.e. – a request is made for a Section 7 medical order – the Lead CE evaluates the request with the responsible claims examiner (RCE), and makes a recommendation to the District Director (DD) and assists in summarizing the questions for reference to DD.
• Assists the DD in researching and preparing his or her oral and/or written communication with stakeholders to effectively explain the results, to discuss case law citations and parties’ positions to mediate contested issues, to resolve complex or controversial problems, and to reach equitable agreement.
• Assists the DD in identifying other applicable statutory or regulatory procedures that can substantiate a claim for DD’s presentation to stakeholders. These options include, but are not limited to, a
  Section 20 CFR 702.315 orders; medical orders; Independent Medical Exams (IME) if medical is the disputed issue; default order if the case was previously adjudicated; or other orders that may be warranted.
• Reviews the recommendation from the RCE to assess self-insured employers or insurance carriers are with civil monetary penalties for non-compliance of statutory reporting requirements. The Lead CE will either reject the RCE’s recommendation to assess a penalty or recommends the DD assesses a civil monetary penalty.
• Examine recommendations to accept Section 8f relief by RCE before transmission to the DD for further evaluation. Assess if the evidence for accepting 8f liability has been provided by the stakeholder. Evaluates all one-time and recurring initiated payment of compensation via the Special Fund and verifies compensation paid by employer/carriers both voluntarily and by Order. Provides guidance to RCE when determining awards of contested attorney fees payable by the employer/carrier or injured workers.
• Independently reviews cases and identifies issues such as discrepancies in the delivery of prompt and proper benefits, awards for permanent impairments, medical management, etc., for Special Fund cases.

Requirements

Conditions of Employment

• Must be at least 16 years old and a U.S. Citizen.
• Appointment to this position may require a background investigation.
• Requires a probationary period if the requirement has not been met.
• Candidate required to obtain the necessary security/investigation level.

Applicants must meet all legal and regulatory requirements. Reference the "Required Documents" section for additional requirements.

Notification Concerning COVID-19 Vaccinations. As required by Executive Order 14043, Federal executive branch employees are required to be fully vaccinated against COVID-19 regardless of the employee's duty location or work arrangement (e.g., telework, remote work, etc.), subject to such exceptions as required by law. If selected, you will be required to be vaccinated against COVID-19 and to submit documentation of proof of vaccination or to be in the process of requesting an exception to the vaccination requirement before appointment or onboarding with the agency. The agency will provide additional information regarding which forms of documentation can be accepted and how you can request to be considered for a legally required exception from this requirement.

Currently, implementation and enforcement of Executive Order 14043 has been suspended pursuant to an injunction pending further litigation.

How You Will Be Evaluated

• Benefits

  Review our benefits

• Required Documents

  As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.

  The following documents must be submitted by 11:59 p.m. (ET) on the vacancy closing date. You are not required to submit a document if it does not apply to you. Warning: If you submit a document using the same document title, the 2nd submission will OVERWRITE the 1st submission. Also, do not upload password-protected documents.

  - Resumes are required - provide a resume either by creating one in USAJOBS or uploading one from your profile. To receive full consideration for relevant and specialized experience, please list the month, year, and the number of work hours worked for the experience listed on your resume. We also suggest that you preview the vacancy questions, and confirm that your resume supports your question responses.

  • Veterans Documents (if applicable): To be considered as a 5-point preference eligible, you must submit a copy of your Certificate of Release or Discharge From Active Duty, DD214. Your DD-214 must show the type of discharge and dates of active duty. To claim 10-point preference, you must submit a copy of your DD214; an Application for 10-point Veteran's Preference, SF15; and the proof of entitlement of this preference which is normally an official statement, dated 1991 or later, from the Department of Veterans Affairs certifying to the present existence of the service-connected disability and indicating the percentage of your disability. (For active duty service members expecting honorable or general discharge or release within 120 days, click Active Duty). Without this documentation, you will not receive veteran's preference. For more information, go to https://www.fedshirevets.gov.

  • Displaced Employee Placement Documents – Only required if requesting priority consideration under CTAP or ICTAP eligibility.

  • Cover Letters are not mandatory and will not be used to verify experience, but may be submitted. Applicants selected for employment who are not current DOL employees will be required to provide proof of citizenship, and the E-Verify system will be used to confirm the employment eligibility of all new hires.

  
  

  If you are relying on your education to meet qualification requirements:

  Education must be accredited by an accrediting institution recognized by the U.S. Department of Education in order for it to be credited towards qualifications. Therefore, provide only the attendance and/or degrees from schools accredited by accrediting institutions recognized by the U.S. Department of Education.

  Failure to provide all of the required information as stated in this vacancy announcement may result in an ineligible rating or may affect the overall rating.

• How to Apply

  To apply for this position, you must complete the initial online application, including submission of the required documentation specified in the "Required Documents" section.

  Follow the steps below to apply. Your application and ALL required supplemental documents MUST be received by 11:59 pm Eastern Time (ET) on the vacancy closing date to receive consideration. Paper applications and supplemental documents submitted in any other manner without prior approval from the vacancy contact will not be considered. Click here for information on Reasonable Accommodations.

  SAVE your information before the 30 MINUTE TIMEOUT! For help, go to USAJOBS Help Center.

  STEP 1 - Create USAJOBS Account on www.usajobs.gov, including Resume and Saved Documents Your resume must provide sufficient information to substantiate your responses to the self-assessment vacancy questions. If not, HR may amend your responses to more accurately reflect the competency indicated by resume content. FOR EACH EMPLOYMENT PERIOD, include: start/end month & year and note full-time or part-time (if part-time, include # of hours worked per week); otherwise, your application may be considered incomplete.

  STEP 2 - Complete the 1st part of the application process (USAJOBS) Once you have identified a job on USAJOBS that you wish to apply for, click on the title and click the "Apply" button. For questions about the vacancy, contact the Agency Contact at the bottom of the announcement. Click “Start Application” and proceed through the 5 steps noted at the top of the USAJOBS page. You will be able to select a resume and documents from your USAJOBS Account that you can submit as a package as part of your DOL application. At Step 5, click “Continue to Agency Site”.

  STEP 3 – Complete the 2nd part of the application process (DOL) On the Department of Labor (DOL) page, create a DOL Account if you have not already and click “APPLY TO THIS VACANCY”. Continue through the 7 progress steps indicated by circles at the top of the DOL page. The 3rd progress step is where you answer the vacancy specific questions. The 4th progress step "Documents" is where you submit required documents (only if applicable to you) specified in the "Required Documents" section of this vacancy. If you submit a document using the same document title, the 2nd submission will OVERWRITE the 1st submission.

  STEP 4 – On the “Review and Submit” step, click “Submit Application” The last “Confirmation” step will turn green noting that your application was submitted successfully.

  STEP 5 - Edit Application as needed by 11:59 pm ET of Closing Date by returning to USAJOBS, clicking the vacancy, then “Update Application”.

  Agency contact information

  William Berenato

  Phone

  215-861-5031

  TDD

  711

  Email

  Berenato.william.h@dol.gov

  Address

  Labor, Ofc of Workers' Compensation Programs
  1835 Market Street
  Suite 2100
  Philadelphia, Pennsylvania 19106
  United States

  Next steps

  Once your complete application is received, we will conduct an evaluation of your qualifications and refer candidates for selection consideration. Candidates will be referred to the hiring manager for further consideration and possible interview. You will be notified of the outcome. A selection is expected to be made within 30 calendar days from the issuance date of the certificate.
  
  For instructions on how to check the status of your application, go to Step 7 on: Using DOORS and USAJOBS Help Guide. To sign up for Application Status Updates via email: Click Here for instructions.

• Fair and Transparent

  The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

  • Equal Employment Opportunity (EEO) Policy
  • Reasonable accommodation policy
  • Financial suitability
  • Selective Service
  • New employee probationary period
  • Signature and false statements
  • Privacy Act
  • Social security number request

Required Documents

Clarification from the agency

US Citizens, CTAP and ICTAP in the local commuting area.