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Insurance Claims Evaluator 2

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Insurance Claims Evaluator 2

Salary

$59,345.00 - $90,211.00 Annually

Location

Dauphin County, PA

Job Type

Civil Service Permanent Full-Time

Job Number

CS-2025-36262-04322

Department

Insurance Department

Division

IN Ustif

Opening Date

11/06/2025

Closing Date

11/19/2025 11:59 PM Eastern

Job Code

04322

Position Number

00208728

Union

AFSCME

Bargaining Unit

A4

Pay Group

ST07

Bureau / Division Code

00095330

Worksite Address

901 North 7th Street

City

Harrisburg, Pennsylvania

Zip Code

17101

Contact Name

Collette Rebuck

Contact Email

[email protected]

Bureau / Division

Insurance Department, Division of Underground Storage Tank Indemnification Fund Claims

+ Description

+ Benefits

+ Questions

THE POSITION

Do you have a keen attention to detail and strong analytical judgment? The Pennsylvania Insurance Department is on the lookout for an Insurance Claims Evaluator 2 with the ability to manage multiple priorities and meet deadlines with accuracy. This position allows you to utilize your insurance background to offer claim handling expertise and oversight to the Fund's Third Party Administrator, ensuring claims are concluded in a cost-effective manner and in accordance with all applicable statutes and regulations. If you have the ability to interpret policies, contracts, and regulations with precision, we have the perfect opportunity for you!

DESCRIPTION OF WORK

Within this role, you will be responsible for reviewing claim status reports submitted by the Third Party Administrator to ensure claims are administered in accordance with the Storage Tank Spill & Prevention Act as well as regulations of the Department and the Board of Directors. Work involves researching claim issues, conducting compliance reviews on files and weekly invoice payments sheets, identifying claim problems and making recommendations for resolution, as well as processing new claims submitted by tank owners, operators, and installers. You will also have the opportunity to answer questions from claimants, providers, attorneys, and legislative staff regarding Fund benefits, payment status, or specific claim issues. Additional responsibilities include:

+ Attending virtual meetings to review claim files and participate in competitive bid scoring sessions

+ Determining eligibility of claims after reviewing appropriate investigation documents

+ Assisting in the development of legislative and regulatory changes

+ Coordinating defense counsel assignments and monitoring counsel activities

+ Assisting with preparation of contracts and requests for proposals

+ Acting as content administrator for the Bureau's website

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=00208728)

Work Schedule and Additional Information:

+ Full-time employment

+ Work hours are 8:00 AM to 4:30 PM, Monday - Friday, with a 60-minute lunch.

+ Telework: You may have the opportunity to work from home (telework) part-time, up to 3 days per week. 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 Harrisburg. The ability to telework is subject to change at any time. Additional details may be provided during the interview.

+ Salary: Selected candidates who are new to employment with the Commonwealth of Pennsylvania will begin employment at the starting annual salary of $59,345.00 (before taxes).

+ 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:

+ One year of experience as an Insurance Claims Evaluator 1 (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration);or

+ Two years of professional experience in the evaluation and payment of claims in multiple lines of insurance and a bachelor’s degree;or

+ An equivalent combination of experience and training.

Other Requirements:

+ You must meet the PA residency requirement (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) . For more information on ways to meet PA residency requirements, follow the link (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) and click on Residency.

+ 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.

EXAMINATION INFORMATION

+ Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).

+ Your score is based on the detailed information you provide on your application and in response to the supplemental questions.

+ Your score is valid for this specific posting only.

+ You must provide complete and accurate information or:

+ your score may be lower than deserved.

+ you may be disqualified.

+ You may only apply/testoncefor this posting.

+ Your results will be provided via email.

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

Have you been employed by the Commonwealth of Pennsylvania as an Insurance Claims Evaluator 1 for one or more years full-time?

+ Yes

+ No

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 many years of full-time professional experience do you possess in the evaluation and payment of claims in multiple lines of insurance?

+ 2 years or more

+ 1 but less than 2 years

+ Less than 1 year

+ None

04

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.

05

How much graduate coursework have you completed in Business Administration or Public Administration? 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.org (”www.naces.org”target=_blank”) and clicking the Evaluation Services Link.

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.

+ 30 credits or more

+ Less than 30 credits

+ None

06

You must complete the supplemental questions below. These supplemental questions are the exam and will be scored. They are designed to give you the opportunity to relate your experience and training background to the major activities (Work Behaviors) performed in this position. Failure to provide complete and accurate information may delay the processing of your application or result in a lower-than-deserved score or disqualification. Youmustcomplete the applicationandanswer the supplemental questions. Resumes, cover letters, and similar documents willnotbe reviewed for the purposes of determining your eligibility for the position or to determine your score.

All information you provide on your application and supplemental questions is subject to verification. Any misrepresentation, falsification or omission of material facts is subject to penalty. If requested, you must provide documentation, including names, addresses, and telephone numbers of individuals who can verify the validity of the information you provide in the application and supplemental questions.

Read each question carefully. Determine and select which "Level of Performance" most closely represents your highest level of experience/training. List the employer(s)/training source(s) from your Work or Education sections of the application where you gained this experience/training.The "Level of Performance" you choose must be clearly supported within the description of the experience and training information entered in your application or your score may be lowered.In order to receive credit for experience, you must have worked in a job for at least six months in which the experience claimed was a major function.

If you have read and understand these instructions, please click on the "Yes" button and proceed to the exam questions.

If you have general questions regarding the application and hiring process, please refer to ourFAQ page (https://www.employment.pa.gov/Additional%20Info/Pages/default.aspx) .

+ Yes

07

WORK BEHAVIOR 1 - CLAIM APPROVAL/DENIAL

Reviews initial claim investigation and status reports submitted by the Third Party Administrator (TPA) to ensure claim investigation are correct and being administered in accordance with all applicable contract requirements, laws, rules, regulations, policies, and procedures. Identifies potential claim eligibility/Regulation issues and recommends appropriate action.

Levels of Performance

Select the Level of Performance that best describes your claim.

+ A. I have experience reviewing insurance claim recommendations and payments for accuracy. I was responsible for identifying issues AND making recommendations for correction.

+ B. I have experience reviewing insurance claim recommendations and payments for accuracy. I was responsible for identifying issues; however, someone else made recommendations for correction based on my analysis.

+ C. I have experience evaluating insurance claims for accuracy. I was responsible for identifying issues and making recommendations.

+ D. I have successfully completed college-level coursework related to program analysis or program evaluation.

+ E. I have NO experience or coursework related to this work behavior.

08

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

+ The name(s) of the employer(s) where you gained this experience.

+ Your experience reviewing insurance claim and/or related recommendations and payments for accuracy.

+ Your experience evaluating insurance claims for accuracy.

+ Your experience identifying issues.

+ Your experience making recommendations for corrections.

09

If you have selected the level of performance pertaining to college coursework, please provide your responses to the three items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

+ College/University

+ Course Title

+ Credits/Clock Hours

10

WORK BEHAVIOR 2 - COMMUNICATION/TECHNICAL ASSISTANCE

Communicates with program stakeholders, claimants, , attorneys, remediation consultants, and various agency peers regarding fund benefits, payment status, or claim issues. Utilizes customer service skills when dealing with adversarial situations.

Levels of Performance

Select the Level of Performance that best describes your claim.

+ A. I have experience communicating with individuals to explain relevant information. I was responsible for diffusing adversarial situations.

+ B. I have experience communicating with individuals to explain relevant information. When dealing with adversarial situations, I escalated these concerns to another person.

+ C. I have successfully completed college-level coursework related to public speaking or customer service.

+ D. I have NO experience or coursework related to this work behavior.

11

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

+ The name(s) of the employer(s) where you gained this experience.

+ Your experience communicating with individuals to explain relevant information.

+ Your experience diffusing adversarial situations.

12

If you have selected the level of performance pertaining to college coursework, please provide your responses to the three items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

+ College/University

+ Course Title

+ Credits/Clock Hours

13

WORK BEHAVIOR 3 - WRITTEN COMMUNICATION

Composes reports, letters, emails, and general responses related to insurance claims activities, problems, inquiries, or program requirements.

Levels of Performance

Select the Level of Performance that best describes your claim.

+ A. I have experience writing reports AND correspondence responses related to insurance claims. I was responsible for the final documents.

+ B. I have experience writing reports or sections of reports related to insurance claims; OR I have experience writing correspondence related to insurance claims.

+ C. I have experience writing reports OR correspondence unrelated to insurance claims.

+ D. I have successfully completed college-level coursework related to business writing, technical writing, English composition, or journalism.

+ E. I have NO experience or coursework related to this work behavior.

14

In the text box below, please describe your experience as it relates to the level of performance you claimed in this work behavior. Please be sure your response addresses the items listed below which relate to your claim. If you indicated you have no work experience related to this work behavior, type N/A in the box below.

+ The name(s) of the employer(s) where you gained this experience.

+ Your experience writing reports - specify if it was related to insurance claims or something else.

+ Your experience writing correspondence - specify if it was related to insurance claims or something else.

15

If you have selected the level of performance pertaining to college coursework, please provide your responses to the three items listed below. If you indicated you have no education/training related to this work behavior, type N/A in the text box below.

+ College/University

+ Course Title

+ Credits/Clock Hours

Required Question

Employer

Commonwealth of Pennsylvania

Address

613 North Street

Harrisburg, Pennsylvania, 17120

Website

http://www.employment.pa.gov