Office Associate II - Claims Unit

State of Maine•Augusta, ME

13d•$17 - $25•Hybrid

About The Position

This unit is responsible for managing the life cycle of approximately 85,000 filings for Workers’ Compensation claims filed in Maine. The unit receives and processes approximately 60,000 paper payment forms annually. Filings are transmitted electronically to initiate a lost time claim or notify the Board of a controversy requiring intervention of the agency and/or its dispute resolution process. This position creates the physical files, maintains the files throughout the life of the claim and determines when the physical files have met the statute of limitations and can be purged. The unit is responsible for maintaining the file room at the Board’s central administrative office and managing the flow of paper claims files to and from the Board’s five (5) regional offices. This position also works with the daily filings of petitions sent to the Augusta Central office. Due to the large volume of the unit this work must be distributed across 7 staff to ensure timely and accurate processing of injured employees' claims. This position is part of the Board’s Claims Management Unit and will have an assigned caseload of insurers, third party administrators and self-insureds. The position works with forms filed, verifies accuracy of information, data and calculations documenting payment of lost-time and medical benefits, contesting claims for benefits, initiating litigation and recording settlement of individual cases. The position also answers questions about Workers’ Compensation benefits.

Requirements

Knowledge of Microsoft Word and Excel.
Ability to work independently.
Ability to receive, screen and give information while maintaining confidentiality.
Ability to communicate effectively orally and in writing with a wide variety of people; adjusters, attorneys, employers, injured workers and IT technical staff.
Ability to obtain and evaluate pertinent information.
Ability to accurately interpret applicable laws, administrative and Law Court decisions and apply them correctly to different dates of injury.
Ability to identify, retrieve, analyze and evaluate data from the Board’s case management system.
Ability to establish and maintain effective working relationships.
Ability to analyze complex issues, reach logical conclusions and make sound recommendations and decisions.
Ability to perform mathematical calculations and formulas and to use Excel spreadsheets to accurately verify calculations submitted to the Board.
Ability to communicate with a wide range of professionals and the public, identify applicable rules and laws, and explain their application to specific instances.
Training, education, or experience in office and administrative support work that demonstrates 1) competency in applying a solid knowledge of modern office practices to perform complex, varied office support tasks, and 2) the ability to use independent decision-making on the appropriate processes to follow, information to process, and actions to take in accordance with standard procedures.
All positions in this classification assume the qualifications of: Office Assistant I, Office Assistant II, and Office Associate I.

Responsibilities

Review and process a variety of forms filed with the Board regarding payment of benefits to injured workers checking for completeness and accuracy, identifying errors, applying the correct rules and statutory requirements depending on the date of injury, calculating &/or verifying rates as needed.
Provide technical assistance to claims managers, adjusters, claims representatives, attorneys and WCB staff for completion and filing of Board forms.
Resolve problems placed into queues such as; incorrect date of birth, Social Security number, misspelled name or change of address.
Maintain batch files for paperwork filed prior to forms being entered.
Sort and match daily paperwork with the correct file.
Handle telephone and email inquiries; assist receptionist as needed.
Identify insurance coverage issues and errors and refer to Board’s Coverage Unit for resolution.
Enter petitions into the Board’s case management system and purge original claim files that have exceeded the statute of limitations.
Respond to requests for files from regional offices, log files in/out and maintain files housed in the file room.

Benefits

Work-Life Balance – Rest is essential. Take time for yourself using 13 paid holidays, 12 days of sick leave, and 3+ weeks of vacation leave annually. Vacation leave accrual increases with years of service, and overtime-exempt employees receive personal leave.
Health Insurance Coverage – The State of Maine pays 85%-100% of employee-only premiums ($11,857.68-$13,950.24 annual value), depending on salary. Use this chart to find the premium costs for you and your family, including the percentage of dependent coverage paid by the State.
Health Insurance Premium Credit – Participation decreases employee-only premiums by 5%. Visit the Office of Employee Health and Wellness for more information about program requirements.
Dental Insurance – The State of Maine pays 100% of employee-only dental premiums ($365.28 annual value).
Retirement Plan – The State of Maine contributes 14.11% of pay to the Maine Public Employees Retirement System (MainePERS), on behalf of the employee.
Gym Membership Reimbursement – Improve overall health with regular exercise and receive up to $40 per month to offset this expense.
Health and Dependent Care Flexible Spending Accounts – Set aside money pre-tax to help pay for out-of-pocket health care expenses and/or daycare expenses.
Public Service Student Loan Forgiveness – The State of Maine is a qualified employer for this federal program. For more information, visit the Federal Student Aid office.
Living Resources Program – Navigate challenging work and life situations with our employee assistance program.
Parental leave is one of the most important benefits for any working parent. All employees who are welcoming a child—including fathers and adoptive parents—receive forty-two (42) consecutive calendar days of fully paid parental leave. Additional, unpaid leave may also be available, under the Family and Medical Leave Act.
Voluntary Deferred Compensation – Save additional pre-tax funds for retirement in a MaineSaves 457(b) account through payroll deductions.
State employees are eligible for an extensive and highly competitive benefits package, covering many aspects of wellness. Learn about additional wellness benefits for State employees from the Office of Employee Health and Wellness.