Claims Services Representative 1 / Trainee 1/2

NY HELP Yes Agency Insurance Fund, State Title Claims Services Representative 1 / Trainee 1/2 Occupational Category Other Professional Careers Salary Grade 18 Bargaining Unit PS&T - Professional, Scientific, and Technical (PEF) Salary Range From $53764 to $85138 Annually Employment Type Full-Time Appointment Type Permanent Jurisdictional Class Competitive Class Travel Percentage 5% Workweek Mon-Fri Hours Per Week 37.5 Workday From 9 AM To 5 PM Flextime allowed? Yes Mandatory overtime? No Compressed workweek allowed? Yes Telecommuting allowed? Yes County Monroe Street Address 100 Chestnut Street City Rochester State NY Zip Code 14604 Duties Description Under the general supervision of a Claims Services Representative 2 responsibilities include, but are not limited to:u2022 Oversee all aspects of workers compensation claims processing from inception to closingu2022 Initially determine the compensability of claims and file appropriate documentation with the Workers Compensation Board (WCB)u2022 Calculate and adjust reserves consistent with case analysis over the anticipated life of the claimu2022 Recommend cases for appeal to WCBu2022 Negotiate and/or make recommendations regarding lump sum settlementsu2022 Issue payments and requests for reimbursement where claims for supplemental benefits are involvedu2022 Review awards to ensure the correct recipient and rate of compensationu2022 Schedule or waive medical examinations as necessaryu2022 Analyze medical bills to determine causality, levels of treatment, necessity for treatment, appropriateness of fees and procedure codes, and apportionment statusu2022 Respond to requests for home modifications, home health care personnel, medication, and medical supplies and appliancesu2022 Review case activity and determine when a claim can be retiredu2022 Specific duties to be discussed at time of interview Minimum Qualifications For appointment via NY HELPS:u2022 To Claims Services Representative Trainee 1: Four years of experience processing Workersu2019 Compensation or Disability Benefits including Paid Family Leave claimsu2022 To Claims Services Representative 1: Six years of experience processing Workersu2019 Compensation or Disability Benefits including Paid Family Leave claimsSubstitutions: An associate degree may substitute for two years of experience; a bacheloru2019s degree may substitute for four years of experience; a masteru2019s degree may substitute for five years of experience; a JD may substitute for six years of experience, and a PhD may substitute for 7 years of experience.For competitive appointment:u2022 List appointment: Reachable on current Civil Service eligible list for this title.u2022 Transfer: Current New York State employee with one year of permanent competitive class service in a title eligible for transfer under Section 70.1 of Civil Service Law. Appointments via transfer must not result in a second, consecutive transfer with an advancement of more than two S-grades or one M-grade. Eligible titles include, but are not limited to: Business Systems Analyst 1, Contract Management Specialist 1, Underwriter 1, Human Resources Specialist 1.u2022 Reinstatement: Candidates who have held a Claims Services Representative 1, or a transferable title, may be eligible for consideration for reinstatement.For 55b/55c Program appointment:u2022 This position may be designated 55 b/c and is subject to verification of applicant eligibility. For more information on this program, please visit the 55b/c Recruitment Resources Center.Please be advised that the New York State Insurance Fund (NYSIF) does not offer sponsorship for employment visas to employees or potential employees. Candidates sponsored for employment by an organization should be aware of their sponsorship status and the relevant expiration date(s) of that sponsorship before applying to this position. NYSIF is not currently enrolled in eVerify, which is a requirement for certain types of employment verifications. Additional Comments For candidates new to NYS, the starting salary for this position will be the bottom of the range displayed and is not subject to negotiation. For candidates that are current NYS employees, salaries are calculated in accordance with NYS Civil Service Law, OSC Payroll rules and regulations, and negotiated union contracts.Fringe Benefits: u2022 Competitive compensationu2022 Future career growth potential u2022 Open and supportive team-based environmentu2022 Plentiful vacation, personal, and sick time offu2022 Paid state and federal holidaysu2022 Affordable health insurance plansu2022 Dental and vision benefits provided at no additional costu2022 Retirement optionsu2022 Public Student Loan Forgiveness (PSLF)u2022 Possibility of telecommuting, flextime, and Alternative Work Schedules (AWS)NY HELPS Program:This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS). For the duration of the NY HELPS Program, this title may be filled via a non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the title for which they apply. At a future date, it is expected employees hired under NY HELPS will have their non-competitive employment status converted to competitive status, without having to compete in an examination. Employees will then be afforded with all the same rights and privileges of competitive class employees of New York State. While serving permanently in a NY HELPS title, employees may take part in any promotion examination for which they are qualified.About NYSIF:For more information about NYSIF, including our mission, commitment to diversity, equity, and inclusion, and efforts to fulfill Executive Order 31, please visit If you are a person with a disability and wish to request that a reasonable accommodation be provided for you to participate in a job interview, please send an email to NYSIFu2019s Reasonable Accommodations mailbox at . Some positions may require additional credentials or a background check to verify your identity. Name Brittany Miller Telephone Fax 518-437-1618 Email Address Address Street PO Box 66699 City Albany State NY Zip Code 12206 Notes on Applying Please submit your resume and cover letter to , referencing the Vacancy ID number in your subject line.

Created: 2026-04-20