Workers' Compensation Specialist

Job Duties

Primary point of coordination, contact, oversight, and problem resolution for compensation payments and insurance benefits. Provide expert technical advice, support, and recommendations to agency management officials, claims examiners, fiscal operations specialists, administrative staff and federal agency personnel on interpretation of policies, programs, regulations, and statutes concerning insurance benefits. Serves as the Federal Employees Health Benefits (FEHB/Federal Employees Group Life Insurance (FEGLI)/Federal Employees Dental and Vision Insurance Program (FEDVIP) point of contact for the program's claimants, beneficiaries, insurance carriers and federal agencies. Serves as a liaison for the Department of Labor's Solicitor's Office on all matters related to third party subrogation payments and surpluses. Assists claims staff with tracking surpluses and administering benefits while surplus is in place. Pulls reports from Treasury and enters appropriate fiscal data in the compensation system. Posts cash receipts received in the National office to Fund Control Register. These monies come from a variety of different sources such as medical provider, third party recoveries, employing agencies, claimants and OPM. Analyzes reports from the Office of Personnel Management's FEHB Centralized Enrollment Clearinghouse System (CLER). Conducts reconciliation actions on all identified discrepancies. Analyzes operations and, as necessary, develops procedures and processes to help prevent internal fraud and abuse, and improve accountability and efficiency. Resolves unusual, delicate, or time-sensitive situations, e.g., those involving congressional inquiry or coordination outside the agency. Resolves the most complex and sensitive insurance benefit case issues with unique situations normally not covered under operating norms or procedure. The incumbent may provide guidance and training to branch employees and claims staff on procedures related to FEHB/FEGLI/FEDVIP benefits and how they impact compensation payments. Reviews policies, practices, written guidance and records to ascertain compliance with DOL and government-wide policy. Identifies areas for improvement and provides guidance and instruction to assist in making improvements. Keeps accurate records and creates reports for tracking payments to groups specifically identified by the Branch Chief.