Metropolitan Transportation Authority Careers

Description

• Responsible for handling a full caseload of medical-only claims from inception to closure in accordance with best practices and statutory, regulatory and ethics requirements.
• Adjust minor lost time cases and negotiate and settle minor schedule loss of use awards.
• Timely investigate claims, determine compensability, and address benefits.
• Set reserves and document rationale in claims system.
• Review files on a consistent basis.
• Ensure claims files are properly documented and claims coding is correct.
• Collaborate with outside counsel and investigators.
• Process settlements/awards and vendor invoices in a timely manner.
• The incumbent will also be responsible for preparing cases for Board hearings, and determining requirements for surveillance, liens, and special investigations.
• Process routine claim payments and prescriptions for lifetime medical and/or PPD claims.
• Perform other related tasks as required by management.

• A master’s degree from an accredited college or university in economics, finance, accounting, business or public administration, human resources management, management science, operations research, organizational behavior, industrial psychology, statistics, personnel administration, labor relations, psychology, sociology, human resources development, political science, urban studies, or a Juris Doctor degree from an accredited law school, and one year of satisfactory full-time professional experience in one or a combination of the following: working with the budget of a large public or private concern in budget administration, accounting, economic or financial administration, or fiscal or economic research; in management or methods analysis, operations research, organizational research or program evaluation; in personnel or public administration, recruitment, position classification, personnel relations, labor relations, employee benefits, staff development, employment program planning/administration, labor market research, economic planning, social services program planning/evaluation, or fiscal management, or in a related area; or
• A baccalaureate degree from an accredited college or university and three years of satisfactory fulltime professional experience in the areas described in "1" above; or
• An associate degree or completion of 60 semester credits from an accredited college and five years of satisfactory full-time professional experience as described in “1” above; or
• A four-year high school diploma or its educational equivalent approved by a State’s department of education or a recognized accrediting organization and seven years of satisfactory full-time professional experience as described in “1” above; or
• A combination of education and/or experience equivalent to “1”, “2”, “3”, or “4” above. College education may be substituted for professional experience at the rate of 30 semester credits from an accredited college for one year of experience. However, all candidates must have a high school diploma and at least one year of experience as described in “1” above.

• A master’s degree from an accredited college or university in economics, finance, accounting,
  business or public administration, human resources management, management science, operations research, organizational behavior, industrial psychology, statistics, personnel administration, labor relations, psychology, sociology, human resources development, political science, or urban studies, or a Juris Doctor degree from an accredited law school; or
• A baccalaureate degree from an accredited college or university and two years of satisfactory fulltime professional experience in one or a combination of the following areas: working with the budget of a large public or private concern in budget administration, accounting, economic or financial administration, or fiscal or economic research; in management or methods analysis, operations research, organizational research or program evaluation; in personnel or public administration, recruitment, position classification, personnel relations, labor relations, employee benefits, staff development, employment program planning/administration, labor market research, economic planning, social services program planning/evaluation, or fiscal management; or in a related area; or
• An associate degree or completion of 60 semester credits from an accredited college or university and four years of satisfactory full-time professional experience as described in "2" above: or
• A four-year high school diploma or its educational equivalent and six years of satisfactory full-time professional experience as described in "2" above; or
• A combination of education and/or experience equivalent to "1", "2", "3", or "4" above. College
  education may be substituted for professional experience at the rate of 30 semester credits from an accredited college or university for one year of experience. However, all candidates must have a high school diploma.

• Knowledge of Workers’ Compensation laws and experience with the Workers’ Compensation Board.
• Knowledge of claims regulations and procedures.
• Excellent oral and written communication skills.
• Excellent analytical, negotiation and organizational skills.
• Knowledge of medical terminology.
• Ability to handle assignments in a timely and professional manner.