Claims Examiner

Title: Claims Examiner

State Role Title: Salary Non-Specified

Hiring Range: Minimum starting salary $47,003, commensurate with experience.

Pay Band: UG

Agency: VA Workers' Compensation Comm

Location: RICHMOND HEADQUARTERS

Agency Website: https://workcomp.virginia.gov/

Recruitment Type: Agency Employee Only - A

This position is open to agency only employees.

Do you wonder who processes the thousands of claims VVF receives from victims of crime?  The Fund has a team of claims examiners who review police reports, medical records, billing statements, and receipts, and determine which expenses are eligible for reimbursement.  

This claims examiner position is not for the faint of heart - you must thrive handling a voluminous case load, utilize critical thinking skills, and stay positive when speaking with frustrated callers. On a brighter note, you will feel appreciated and supported by an engaging team, you will enjoy a healthy work life balance in a telework environment, and you will feel a deep sense of pride in your work. If you’re still reading and are interested, this may be the perfect opportunity for you!

Job Duties

Virginia Workers’ Compensation Commission administers the Virginia Compensating Victims of Crime Act through the Criminal Injuries Compensation Fund also known as the Virginia Victims Fund (VVF).  The Criminal Injuries Compensation Fund helps victims of violent crime with out-of-pocket expenses including medical bills, prescriptions, funeral expenses, and many other expenses.  While money can never erase the scars and painful memories of a crime, our programs may ease some of the financial burdens faced by victims and their families.  

The Criminal Injuries Compensation Fund is seeking a highly qualified, energetic team player to fill one Claims Examiner positions.  This position will initiate the claims process, review files for accuracy and completeness, make follow-up requests, as needed, and examine documentation that supports the basis of the claim in order to determine eligibility. This position also examine circumstances of crime to determine eligibility, determine amount of awards, analyze collateral resources, apportion, reduce, or compromise, if necessary, and make claim determinations based upon documentation and information received from claimant and stakeholders. Additional responsibilities include answering inquiries and corresponding with clients and allied professionals via phone or in person; corresponding and collaborating with stakeholders to promote and enhance the claims process; and supporting training and outreach. This position may also help manage VVF's grants.  Must past criminal background check as a condition of employment. 

Minimum Qualifications

• Experience providing high-volume case management in a fast-paced, criminal justice, human services, or related environment
• Experience with claims examination to include billing and payment determination
• Experience interacting with a diverse group of professionals and customers via verbal and written communication
• Experience gathering information and creating and presenting reports
• Working knowledge of victims' issues and the resources available to victims; Virginia's criminal justice system and/or criminal code
• Strong analytical and logical reasoning and administrative research skills and abilities
• Strong work ethic and attention to detail
• Demonstrated ability to exercise good judgment and work within deadlines in a high volume, fast-paced environment
• Demonstrated ability to work both independently and as part of a team
• Ability to travel overnight on occasion
• Proficiency with Microsoft applications including Word, Outlook, Power Point, and Excel; data entry and retrieval from computer databases such as CICF, VEC, and LOPAS; and Internet research principle

Additional Considerations

• Experience with claims examination, case management, victims' compensation, and/or the Code of Virginia sections applicable to CICF
• Working knowledge of the Code of Virginia sections relating to the Criminal Injuries Compensation Fund and medical billing processes and terminology
• Knowledge of federal grant processes to occasionally assist with managing VVF grants. 

Special Instructions

You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to “Your Application” in your account to check the status of your application for this position.

 

Contact Information

Name: Amy Habel

Phone: 804-205-3571

Email: HR.recruiting@workcomp.virginia.gov

 

In support of the Commonwealth’s commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.

Note: Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.