Workers' Compensation Claims Examiner

Clarification from the agency

This position is open to open to current/former career/career conditional Federal employees with competitive eligibility; certain Military Spouses, Land Management, OPM Interchange Agreement, Reinstatement, Veterans Employment Opportunities Act (VEOA), ICTAP and CTAP eligibles in the local commuting area. Also advertised as job # DE-26-PHIL-OWCP-13075977-MS: open to all U.S. citizens

This job is also open in another announcement to:

The public

Career transition (CTAP, ICTAP, RPL)

-Properly examine medical and other factual evidence for claims for benefits involving work-place injuries and/or illnesses for factual sufficiency and legal correctness to determine if the compensation claim and/or medical benefit claim meets the criteria outlined in established policies, procedures, or other guidelines.
-Prepare correspondence and maintain working relationships with claimants, witnesses, employers, physicians, medical providers, investigators, representatives, attorneys, and other sources to obtain missing or supplemental medical and employment documents, to clarify information, and to secure additional factual and medical information needed to adjudicate the claim.
-Provide technical assistance and advice to claimants and/or their representatives on eligibility for benefits.
-Review and evaluate a variety of evidentiary documents (e.g., narrative medical reports commenting upon the relationships of the disability to the implicated employment factors, history of claimant's disability and health history, specifics of employment felt to be the cause of injury, job descriptions, workplace exposures, comments on the veracity of the claimant's statements, employment records, letters or certificates of medical necessity , etc.) from a variety of sources submitted with or subsequent to the initial claim.
-Familiar with the appropriate program statute, regulations, and policies so that they can perform specialized adjudicatory functions required by the appropriate program's procedure manual to determine the amount of compensation to be paid, the duration of periodic compensation, and/or reimbursement for medical or other expenses.
-Respond in writing and/or via telephone, as appropriate, to received written correspondence, telephone messages, or inquiries via automated system.
-Apply knowledge of workers' compensation laws, regulations, and policies to develop and make determinations on the proper disposition of claims for assigned cases.
-Maintain and update claim data within appropriate applications (e.g., claims database, bill pay applications, or parallel applications) to reflect the status and level of entitlement.

Conditions of employment

• Must be at least 16 years old.
• Must be a U.S. Citizen.
• Candidate required to obtain the necessary security/investigation level.
• Requires a probationary period if the requirement has not been met.

Qualifications

IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE. Position titles alone cannot be used to determine if you are qualified. Please list dates in MM/DD/YY format. This is imperative in determining if whether you have at least one year of creditable specialized experience. Dates will not be assumed.

Applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-5 in the Federal Service.

Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level.

Qualifying specialized experience for GS-7 includes:
1. Receiving and evaluating forms, reports, and supporting documents for accuracy and completeness.
2. Using basic medical terminology associated with illnesses and injury.
3. Communicating with customers to elicit or convey technical information.
4. Writing correspondence of a business nature seeking information, recommendations or decisions.

or

Education:1 full year of graduate level education (One year of full-time graduate education is considered to be the number of credit hours that the school attended has determined to represent 1 year of full-time study. If that information cannot be obtained from the school, 18 semester hours should be considered as satisfying the 1 year of full-time study requirement).

or

superior academic achievement (General Schedule Qualification Policies)

or

Combination of Education and Experience: A combination of education and experience may be used to qualify for this position as long as the computed percentage of the requirements is at least 100%. To compute the percentage of the requirements, divide your total months of experience by 12. Then divide the total number of completed graduate semester hours (or equivalent) by 18. Add the two percentages.

ELIGIBILITY REQUIREMENTS: Applicants must meet the eligibility requirements of time-in-grade (52 weeks at the next lower grade), time-after-competitive-appointment (90 days), and minimum qualifications (52 weeks equivalent to the next lower grade in federal service). These requirements must be met within 30 days of 10/05/2026 the announcement closing date.

How you will be evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Your evaluation will be based on how well you meet the qualifications outlined in this vacancy announcement, as demonstrated through your resume and supporting documentation.

You may preview application questions for this vacancy here: https://apply.usastaffing.gov/ViewQuestionnaire/13075978

USA Hire

You will be assessed on the following competencies (knowledge, skills, abilities, and other characteristics):

• Attention to Detail
• Customer Service
• Flexibility
• Integrity/Honesty
• Interpersonal Skills
• Reading Comprehension
• Teamwork

The information you provide may be verified by a review of your paid, unpaid, and volunteer, as it demonstrates the competencies or skills required for the position to be filled. Your evaluation may include an interview, reference checks, or other assessment conducted by HR specialists, subject matter experts, or panel members and may include other assessment tools (ex. interview, structured interview, written test, work sample, etc.).

INFORMATION FOR ICTAP/CTAP ELIGIBLE(S) ONLY: If you are eligible for special priority selection under ICTAP/CTAP, you must be well-qualified for the position to receive consideration. ICTAP/CTAP eligible(s) will be considered well-qualified if they attain at least a rating score of 85 in a numerical rating scheme. Be sure to review the eligibility questions to reflect that you are applying as an ICTAP or CTAP eligible and submit supporting documentation.

The following documents must be submitted by 11:59 p.m. (ET) on the vacancy closing date.

The following documents are required from all applicants (PLEASE READ CAREFULLY):

• FEDERAL STATUS APPLICANTS: When applying as a status candidate with current or former Federal Service, please provide a copy of your last or most recent SF-50, Notification of Personnel Action which shows your appointment eligibility for the position for which you are applying. Your SF-50 must identify the highest grade you held on a permanent basis, Pay Plan/Pay Schedule, Series, Grade/Pay Band, and career status. Multiple SF-50 may be submitted to demonstrate your highest previous rate and eligibility.

*WARNING: An award SF-50 (ex. cash or time off award) may not indicate grade, step, and competitive status. For current DOL employees, an award SF-50 DOES NOT indicate grade and step.

• Resumes are required - provide a resume either by creating one in USAJOBS or uploading one from your computer and USAJOBS profile. To receive full consideration for relevant and specialized experience, please list the month, year, and number of work hours worked for the experience listed on your resume. We also suggest that you preview the vacancy questions and confirm that your resume supports your question responses.
• Most recent performance appraisal/evaluation signed and dated within 18 months is requested by the agency but will not disqualify candidates if not submitted. If not submitted during the application process, one may/will be requested at the time of the interview if the opportunity is extended. *In most cases, ICTAP/CTAP applicants must submit this document - please see ICTAP/CTAP links below for more details.

The following documents are required (if applicable):

• Displaced Employee Placement Documents - Only required if requesting priority consideration under Interagency Career Transition Assistance Plan (ICTAP) and Career Transition Assistance Plan (CTAP) Eligibility. Click/Review these ICTAP/CTAP links to confirm what must be submitted as proof that the requirement has been met.
• DD-214 - verifying military service, eligibility for consideration under the Veterans Employment Opportunity Act (VEOA), and showing the character of discharge (ex. Member Copy 4 and 2 are acceptable vs. Copy 1 which is not acceptable to adjudicate veteran's preference)
• Special/Non-Competitive Appointing Authority Documents - Applicants who are eligible for consideration, and wish to be considered, under one of the following non-competitive hiring authorities must submit appropriate documentation (click on the links below to see the documentation requirements): (a) Military Spouses (MISP) (b) Other
• Land Management Eligible(s): a copy of your most recent Notification of Personnel Action (SF-50 or equivalent) proving your eligibility for appointment under the Land Management Workforce Flexibility Act. This service must have been performed in competitive service, under a time-limited appointment in a Land Management Agency, as defined by P.L. 114-328. For more information, click here.
• Unofficial Transcript(s) (in English) - If you are using education as a basis for qualifying for this position, you must submit all applicable academic transcripts demonstrating that you meet the qualifying educational requirements (ex. BA/BS, MA, JD, Ph.D., etc.). If specific coursework is required to qualify, you must supply an unofficial transcript from each academic institution in which the required courses were taken in order to receive credit. You may upload your unofficial transcript(s) as one document with a maximum size limit of 5 MB.

NOTE: The OFFICIAL Transcript(s) MUST BE RECEIVED, if you are selected, and prior to receiving the firm offer with a start date.

Reference the Education Section for College Transcript and Evaluation of Foreign Education.

Do not upload password-protected documents.

Applicants selected for employment who are not current DOL employees will be required to provide proof of citizenship, and the E-Verify system will be used to confirm the employment eligibility of all new hires.

As a condition of employment for accepting this position, you may be required to serve a 1 year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:

- your performance and conduct;
- the needs and interests of the agency;
- whether your continued employment would advance organizational goals of the agency or the Government; and
- whether your continued employment would advance the efficiency of the Federal service.

Upon completion of your 1 year probationary period your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.

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