Claims Examiner

State of Georgia • Atlanta, GA

350d • $55,000

About The Position

The Criminal Justice Coordinating Council (CJCC) is administratively attached to GBI. CJCC is legislatively charged with eleven areas of criminal justice coordination. Among those responsibilities is to serve as the statewide clearinghouse for criminal justice information & research. Develop criminal justice legislative & executive policy proposals; & serve in an advisory capacity to the Governor on issues impacting the criminal justice system. CJCC plans & administers tens of millions of dollars in federal criminal justice and victim services grants. Under limited supervision, the Claims Investigator is responsible for the accurate and timely processing of Victims Compensation claims. Investigators at this level are assigned claims, which require a high level of skill in the application of rules and regulations governing the Georgia Crime Victims Compensation Program. This includes utilizing extensive analytical, investigative, and critical thinking skills to obtain necessary information to accurately, and efficiently make overall claim and payment recommendations. The Investigator will be subject to divisional standards of quality and productivity.

Requirements

• High school diploma/GED and one (1) year of job-related experience.

Nice To Haves

• Minimum of two years of experience with a program with proven claim monitoring and investigative experience.

Responsibilities

• Review and investigate claims to determine eligibility according to Crime Victims Compensation Law of Georgia and/or rules and regulations that govern the Crime Victims Compensation Program.
• Exercise independent decision-making, problem solving, and the utilization of written, oral, and interpersonal communication skills.
• Handle highly sensitive and confidential victim information, including medical records and reports to determine benefit eligibility.
• Review all documentation for accuracy and completeness.
• Complete an Investigative Summary with a recommendation regarding claim eligibility.
• Accurately document claims in the claims management system.
• Adhere to processing timelines for all claim related work.
• Make recommendations on disbursement of payments for each allowable category (e.g., medical, counseling, funeral expenses, etc.) as is provided under the state law.
• Verify all bills submitted with the application and make appropriate bill payment recommendations, to include correct no pay reasons when a bill payment is denied.
• Thoroughly review claims to assure that all billing information is related to the incident/victimization.
• Demonstrate the ability to pay close attention to details and employ changing reimbursement guidelines as warranted.
• Coordinate information exchange between all necessary entities, including law enforcement, service providers, hospital/medical centers, advocates, and social service agencies to ensure claim/bill eligibility.
• Review claim application packets to ensure statutory program requirements have been met.
• Research/Request additional information from any and all entities that may impact claim decisions.
• Assist with answering inquiries and explaining rules and regulations regarding the State of Georgia Crime Victims Compensation Program.
• Accurately answer inquiries regarding claims processing status, payment of benefits reimbursements.
• May provide informational material regarding forms, requirements, timelines etc. regarding filing a claim.
• Effectively explains Crime Victims Compensation Program rules and regulations.
• Utilize excellent customer service skills and communicates effectively and tactfully with victims and their families to ensure questions are properly handled, and concerns are resolved in a timely manner.
• Demonstrate strong communication skills in person, by phone, and in writing, including documentation and report-writing skills.

Benefits

• Health and Flexible Benefits
• 13 Paid State Holidays
• Annual & Sick Leave
• Teleworking Options Available

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Executive, Legislative, and Other General Government Support
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees