• Department Of Labor
  • $69,405.00 -128,950.00/year*
  • Philadelphia , PA
  • Financial Services - Insurance
  • Full-Time
  • 1103 Market St


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* Duties

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Duties

Summary

This position is located within the U.S. Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), Division of Federal Employees' Compensation (DFEC), Branch of Program Integrity, Fraud Prevention & Prescription Management (PIFPPM).

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Responsibilities

THERE IS ONE POSITION TO BE FILLED. THE POSITION MAY BE FILLED IN ANY ONE OF THE FOLLOWING LOCATIONS:

Washington DC $137,849 - $166,500 Philadelphia, PA $133,564 - $166,500 Kansas City MO $124,290 - $161,575

Denver, CO $134,629 - $166,500 Jacksonville, FL $123,298 - $160,286 Seattle, WA $134,352 - $166,500

San Francisco, CA $149,606 - $166,500 Dallas, TX $132,402 - $166,500 Boston, MA $136,729 - $166,500

New York, NY $141,835 - $166,500 Chicago, IL $136,495 - $166,500 Cleveland, OH $128,394 - $166,500

The mission of the DFEC is to administer the Federal Employees' Compensation Act (FECA) (5 U.S.C. ? 8101 et. seq.) by developing and adjudicating new claims for benefits, managing ongoing claims, authorizing and paying medical and compensation benefits to injured worker and survivors, and helping injured employees return to work when they are able to do so.

* This position is outside the bargaining unit.
* Additional selections may be made from this announcement.
* Applicant must be able to obtain a Tier 4 level investigation.
* PCS/Relocation funds are not available.

Serves as the authority on FECA and medical management with expertise in the medical aspects of work-related diseases and injuries within a workers' compensation system. Monitors and manages ongoing entitlement to benefits, which includes the following: the use of prescriptions, to include opioid and compounded medications; providing guidance to claims staff on the use of pharmaceuticals in cases where a claimant is receiving such a product for any work-related condition; detecting suspicious and fraudulent medical provider billing practices or other fraudulent activities within the program; and taking necessary action to deter such behavior.

Independently adjudicates highly complex disability cases. Examines injury and disease cases for factual and medical sufficiency and legal correctness. Conducts appropriate research and investigation to ensure that claims decisions are consistent with law, regulations, opinions of the Solicitor, etc. Assumes responsibility for cases under investigation for potential fraud.

Provides authoritative counsel, review, adjudication, and decisions to staff on cases that have unusual and complicated questions, which may have Agency policy implications, or when interpretations or judicial precedents have not been established.

Provides technical expertise pertaining to claimant and provider fraud and assists with prosecutorial actions. Coordinates expert witness testimony for criminal and civil trials associated with FECA fraud. Makes decisions in areas such as: developing short- and long-range strategic plans for program operations; recommending changes in organizational structure in response to workload or program changes; developing policy and procedures; dealing with significant external interests in program operations.

Oversees direct medical management of all claims where the injured worker has been receiving opioids on a long-term basis. This includes reviewing utilization of Prescription Drug Monitoring Programs and evaluation of non-opioid therapies and opioid dependency risk and communicating with the prescriber, second opinion examinations, field nurse assignment, addiction treatment program approval and formal denials, as needed.

Oversees the development of data analytics and dashboards. Ensures that performance data and trend analysis is used to spot payment anomalies and/or spikes based on both historical and projected outlays, which includes quarterly spend reports and other more targeted reports such as opioid and compounds usage reports.

Provides oversight and management of PIFPPM program activities and staff (e.g., Workers' Compensation Claims Examiners, Investigative Analysts, and Program Analysts). Responsibilities include, but are not limited to the following: plans work to be accomplished; sets and adjusts priorities; prepares schedules for completion of work; manages and monitors the day-to-day operations to ensure that program objectives are being met; establishes priorities and discusses goals and objectives with management and staff.

Travel Required

Occasional travel - For training purposes.

Supervisory status

Yes

Promotion Potential

15 - This position has no further promotion potential.


* Job family (Series)

0991 Worker's Compensation Claims Examining


* Requirements

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Requirements

Conditions of Employment

* Must be at least 16 years old and a U.S. Citizen.
* Appointment to this position may require a background investigation.
* Candidate required to obtain the necessary security/investigation level.
* Requires a probationary period if the requirement has not been met.
* Subject to financial disclosure requirements.

Applicants must meet time-in-grade, time-after-competitive-appointment and qualifications requirements within 30 calendar days after the closing date of the vacancy to be eligible for consideration for selection.

Federal Employees Please Note: Your SF-50 must include enough information to be able to determine that time-in-grade requirements have been met and reflects your position title, pay plan/series/grade, tenure and the type of appointment (i.e. competitive/excepted). In some cases you may need to submit more than one SF-50.

Reference the \"Required Documents\" section for additional requirements.

Qualifications

IN DESCRIBING YOUR EXPERIENCE PLEASE BE CLEAR AND SPECIFIC. WE WILL NOT MAKE ASSUMPTIONS REGARDING YOUR SPECIALIZED EXPERIENCE.

Applicants must have at least 52 weeks experience at the next lower level in the normal career progression of the position being filled. When compared to Federal experience, this experience must be equivalent to at least the next lower grade level of GS-14. This experience may have been gained either in the Federal or Private sectors, demonstrating expert knowledge of Federal laws and OWCP policies and procedures to direct all Program Integrity, Fraud Prevention, and Prescription Management policy activities and program initiatives that impact the Departmental administration of one of the Agency's regulatory workers' compensation programs.

Applicants must have experience in directing and overseeing verification of continuing entitlement to benefits to include pharmaceuticals and detecting and preventing fraud in the Federal Employees Compensation Act (FECA).

Education

There is no educational substitution for this position.



Associated topics: adjuster, automobile, bodily, casualty, claim, claim adjuster, damage, insurance, insurance examiner, liability

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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