Workers' Comp Claims Examiner

Job Summary This position is located in the DC Office of Risk Management (DCORM), Public Sector Workers’ Compensation. The role provides claims management support for the Public Sector Workers' Compensation Program (PSWCP), a system of benefits for workers with job‑related injuries or illnesses. Duties and Responsibilities Receive first notices of loss from District Government employees reporting or filing claims. Determine entitlement to Workers’ Compensation benefits and administer medical‑only claims. Collect and analyze supporting data, evaluate medical evidence, and make decisions on billing and treatment. Research electronic files, schedule appointments, and follow up on progress. Arrange transportation services for claimants as needed. Conduct 24‑hour, 4‑point contact with injured workers, supervisors, healthcare providers, and nurse case managers after injury reporting. Record statements, draft Notices of Determination, and administer medical benefits on accepted claims. Manage a caseload from inception to resolution, maintaining open and closed claims. Attend agency claim review sessions and assist in trials and mediation. Communicate with medical providers and claimants to clarify conflicting opinions. Prioritize professional customer service with injured workers, medical professionals, and the public. Qualifications and Education At least one (1) year of specialized experience equivalent to the next lowest grade level. Highly desired: minimum two years of hands‑on experience in claims management or workers’ compensation. Licenses and Certifications None Working Conditions/Environment Performed primarily in an office setting, with occasional duties outside the office. Other Significant Facts Tour of Duty: Monday – Friday; 8:30 am – 5:00 pm Pay Plan, Series and Grade: CS-0991-09 Promotion Potential: No known promotion potential. Duration of Appointment: Career Service Term Appointment – Not‑To‑Exceed (NTE) 13 months. Continued employment contingent on funding. Collective Bargaining Unit: Not covered. Position Designation: Enhanced suitability screening (Security Sensitive). Residency Preference: Requires bona‑fide District residency for seven (7) consecutive years. EEO Statement The District of Columbia Government does not discriminate or retaliate in employment on the basis of race, color, religion, sex, pregnancy, gender identity and expression, national origin, family responsibilities, political affiliation, sexual orientation, marital status, homeless status, disability, genetic information, age, membership in an employee organization, participation in a legally protected activity, parental status, matriculation, personal appearance, credit information, status as a victim or family member of a victim of domestic violence, sexual offense, or stalking, military service, or other non‑merit factor. #J-18808-Ljbffr DC Department of Human Resources