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State Workers' Insurance Fund Claims Representative

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State Workers' Insurance Fund Claims Representative

Salary

$45,907.00 - $69,203.00 Annually

Location

Philadelphia County, PA

Job Type

Non-Civil Service Permanent Full-time

Job Number

N-2025-35086

Department

Department of Labor & Industry

Division

LI SWIF Philadelphia Dstr Off

Opening Date

10/21/2025

Closing Date

10/25/2025 11:59 PM Eastern

Job Code

70350

Position Number

50272125

Union

AFSCME

Bargaining Unit

G1

Pay Group

ST05

Bureau / Division Code

00121644

Bureau / Division

LI SWIF Philadelphia District Office

Worksite Address

801 Market Street

Worksite Address

Suite 4101

City

Philadelphia, Pennylvania

Zip Code

19102

Contact Name

Felicia Newbury

Contact Email

[email protected]

+ Description

+ Benefits

+ Questions

THE POSITION

Are you ready to take the next step in your career? If so, consider joining the Department of Labor & Industry, State Workers' Insurance Fund (SWIF) as a Claims Representative. This position gives you the opportunity to investigate, process, and manage reported work-related claims or injuries for employees of policy holders covered by the State Workers’ Insurance Fund for the purpose of determining compensability. If you are an analytically minded professional with a keen eye for detail, we need you on our team!

DESCRIPTION OF WORK

As a Claims Representative, your focus will be on completing investigations for reported work related or injury incidents or claims; processing acceptance or denial within 48 hours of receiving the assignment. The investigation must include consideration of the course and scope, employment relationship and may include, but should not be limited to vehicle accident, coming and going, if appropriate to the assigned office, firefighter affiliation, undocumented worker, misclassification, and all other information that is necessary to determine compensability of the present claim. You will have the opportunity to monitor and control all aspects of the claim to conclusion in accordance with established authority and procedure. You can expect to handle all aspects of minor disability or lost time claims with closed periods of disability or anticipated lost time of less than eight weeks.

Additional duties to include but not limited to:

+ Making determinations to identify potential fraud, documenting and reporting all suspected fraud to the SWIF fraud investigator and supervisor

+ Identifying and making recommendations to supervisor when identified excess use of Physical Therapy or Durable Medical Equipment supplies have been ongoing for an extended or excessive period of time

+ Ensuring claim intake data is complete and accurate including but not limited to claimant data, employer data, NAICS and incident information

+ Contacting appropriate parties related to the reported claim including claimant, employers, doctors, hospitals, and witnesses to determine eligibility for workers’ compensation benefits

Interested in learning more? Additional details regarding this position can be found in the position description (https://careers.employment.pa.gov/pd/PD\_NEOGOV.asp?p=50272125) .

Work Schedule and Additional Information:

+ Full-time employment

+ Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with 30-minute lunch.

+ Telework: You may have the opportunity to work from home (telework) part-time. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Philadelphia. The ability to telework is subject to change at any time. Additional details may be provided during the interview.

+ Salary: In some cases, the starting salary may be non-negotiable.

+ You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY

QUALIFICATIONS

Minimum Experience and Training Requirements:

+ Two years of clerical work experience that includes collecting, recording, compiling, or preparing documents for medical, health, or work-related insurance claims;or

+ An equivalent combination of experience and training.

Additional Requirements:

+ You must be bilingual/fluent in Spanish.

+ You must demonstrate the ability to adhere to the values and ethics of the Department of Labor and Industry.

+ You must demonstrate the ability to work with professionalism, discretion, and good work ethic.

+ You must have solid written and verbal communication skills.

+ You must show initiative and problem-solving skills.

+ You must be able to perform essential job functions.

How to Apply:

+ Resumes, cover letters, and similar documents willnotbe reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).

+ If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.

+ Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.

+ Failure to comply with the above application requirements may eliminate you from consideration for this position.

Veterans:

+ Pennsylvania law (51 Pa. C.S. §7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.pa.gov/agencies/employment/how-to-apply.html and click on Veterans.

Telecommunications Relay Service (TRS):

+ 711 (hearing and speech disabilities or other individuals).

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.

Learn more about our Total Rewards by watching this shortvideo (https://www.youtube.com/embed/HtcSRnndflc?rel=0) !

See the total value of your benefits package by exploring ourbenefits calculator.

Health & Wellness

We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.*

Compensation & Financial Planning

We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options.

Work/Life Balance

We know there’s more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.*

Values and Culture

We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.

Employee Perks

Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships.

For more information on all of these Total Rewards benefits, please visitwww.employment.pa.gov and click on the benefits box.

*Eligibility rules apply.

01

How many years of full-time clerical work experience that includes collecting, recording, compiling, or preparing documents for medical, health, or work-related insurance claims do you possess?

+ 2 years or more

+ 1 but less than 2 years

+ Less than 1 year

+ None

02

If you are claiming experience in the above question, please list the employer(s) where you gained this experience in the text box below. The employer(s) and a description of the experience must also be included in the appropriate sections of your application if you would like the experience to be considered in the eligibility decision. If you claimed you do not have experience, type N/A in the text box below.

03

How much college coursework in any field of study have you completed? If you are claiming credits/degree, you must upload a copy of your college transcript(s) for this education to be considered in the eligibility decision. Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a transcript(s) to the application after it has been submitted.

If your education was acquired outside of the United States, you must upload a copy of your foreign credential evaluation report. We can only accept foreign credential evaluations from organizations that are members of the National Association of Credential Services (NACES). A list of current NACES members can be found by visitingwww.naces.organd clicking the Evaluation Services Link.

For additional information on foreign education credentials, please visithttps://www.employment.pa.gov/Additional%20Info/Pages/default.aspx#q3and click on Other Information.You must attach your documentation prior to the submission of your application by using the "Attachments" tab on the left. You will not be able to add a document to the application after it has been submitted.

+ Associate's degree or higher

+ 30 but less than 60 credits

+ Less than 30 credits

+ None

04

Additional Requirement - Are you bilingual/fluent in Spanish?

+ Yes

+ No

Required Question

Employer

Commonwealth of Pennsylvania

Address

613 North Street

Harrisburg, Pennsylvania, 17120

Website

http://www.employment.pa.gov