Uninsured Employer Fund(UEF) Specialist

State of Maryland•Baltimore City, MD

18h•Onsite

About The Position

The main purpose of this position is to oversee the review, investigation, and processing of workers’ compensation claims involving potentially uninsured employers. Serving as a subject matter expert within the Claims Division, the role ensures that claims are accurately evaluated for Uninsured Employers Fund (UEF) eligibility and handled in compliance with applicable laws and regulations in accordance with COMAR 14.09.05. By conducting detailed coverage research and collaborating with internal divisions, this position supports the agency’s mission to protect injured workers and uphold employer compliance, particularly in response to increased expanded Employer Compliance initiatives.

Requirements

Graduation from an accredited high school or possession of a high school equivalency certificate.
One year of administrative staff or professional work.
Candidates may substitute 30 college credit hours from an accredited college or university for the required experience.
Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer involving staff work that included regular use of independent judgment and analysis in applying and interpreting complex administrative plans, policies, rules or regulations or analysis of operational programs or procedures with recommendations for improvement on a year-for-year basis for the required experience.

Nice To Haves

Three (3) or more years of experience investigating and adjudicating workers' compensation claims, including determining compensability, gathering, and evaluating evidence, and documenting claim findings.
Working knowledge of Maryland workers' compensation laws, regulations, and procedures, including familiarity with COMAR 14.09.05.01 and related provisions governing uninsured employers.
Demonstrated ability to exercise independent judgment in interpreting and applying complex statutes, regulations, administrative plans, policies, and procedures.
Strong analytical and investigative skills, with the ability to evaluate conflicting information, identify relevant facts, and make well-supported recommendations or determinations.

Responsibilities

Independently review and analyze claims to determine eligibility for designation under the Uninsured Employers Fund (UEF).
Conduct detailed investigations into employer insurance coverage status at the time of injury.
Compile and document findings and communicate determinations to the Insurance Compliance Division as well as other constituents.
Serve as the primary point of review for claims coded or flagged as potential UEF cases.
Independent judgment and analysis in applying and interpreting complex administrative plans or policies.
Confers with other administrative officials, program heads, staff specialists or others in order to exchange information pertaining to UEF claims or interpret policies or offer recommendations.
Manage Workers’ Compensation UEF claims from initial intake through final resolution.
Review, analyze, and process claims documentation for completeness, accuracy, and compliance.
Ensure UEF claims contain the required claimant’s questionnaire in accordance with COMAR 14.09.02.
Ensure timely and equitable routing of documents and actions through the CompHub system.
Apply working knowledge of COMAR14.09.05.01 regulations and Workers’ Compensation statutes to claims handling activities.
Ensure all actions and decisions adhere to legal and procedural requirements.
Identify and escalate compliance issues as appropriate to the Insurance Compliance Division, NCCI, UEF, and/or Director of Claims.
Monitor claims where attorneys for employer/insurers have not entered their appearance in a claim in accordance with COMAR 14.09.02.08.
Receives and codes workers' compensation claims and related case documents.
Reviews claims for completeness, accuracy and compliance with agency regulations and procedures.
Independently monitor and process workers’ compensation claims from inception through resolution.
Review claims to ensure compliance with COMAR 14.09.02.08 regarding attorney entries of appearance for employers and insurers.
Contact insurers, employers, and legal representatives concerning missing or incomplete attorney appearances.
Provide technical guidance and expertise related to workers’ compensation claim procedures and regulatory compliance requirements.
Initiate corrective actions for non-compliance, including preparation and issuance of warning letters.
Maintain accurate claim records, correspondence, and documentation within applicable systems.
Coordinate with internal staff and external stakeholders to support timely claim administration and compliance enforcement.
Determines whether claims may be compensated or deferred for a hearing or held pending the receipt of additional information.
Contacts claimants, employers, insurers, attorneys and other members of the compensation community to obtain and clarify pertinent information.
Rescinds orders, withdraws claims and amends awards as appropriate.
Explains workers' compensation laws and procedures to claimants, employers, insurers, members of the legal and medical professions, and other interested parties.
Other Duties as assigned