TENTATIVE

Occ. Code 6813850

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS SERIES

          The Assistant Directors Compensation Claims & Medical Administration and Director Compensation Claims & Medical Administration oversee the New York State Insurance Funds claims and medical administration functions performed in various business offices throughout the State.

          These positions are only classified at the New York State Insurance Fund.

DISTINGUISHING CHARACTERISTICS

          ASSISTANT DIRECTOR COMPENSATION CLAIMS & MEDICAL ADMINISTRATION: assists the Director Compensation Claims & Medical Administration with overseeing and coordinating the claims and medical administration program.

          DIRECTOR COMPENSATION CLAIMS & MEDICAL ADMINISTRATION: one-position class; directs the Claims and Medical Administration Department. 

ILLUSTRATIVE DUTIES

          ASSISTANT DIRECTOR COMPENSATION CLAIMS & MEDICAL ADMINISTRATION: reporting to the Director Compensation Claims & Medical Administration, provides the daily oversight and coordination of claims and medical administration functions; implements departmental operating policies, and ensures uniform operating procedures and quality assurance standards for all functions performed under the Workers Compensation Law, the Volunteer Ambulance Workers Benefit Law, the Volunteer Firefighters Benefit Law, and the Disability Benefit Law; develops staff and ensures that staff meet department and agency objectives and goals; reviews claims processing data statewide to assess case statuses by district office and as appropriate evaluates requests for changes in staffing levels or performance standards or department policies and procedures; directs improvements to electronic programs or systems consistent with business needs; oversees programs which involve the selection and retention of physicians for conducting medical examinations of workers compensation and disability benefits claimants; reviews departmental budgets to control costs and allocate funds in accordance with executive management goals and objectives; meets with occupational safety groups and trade managers, brokers, executives, attorneys, policyholders, claimants, medical care providers and other insurance carriers to resolve complaints or respond to inquiries; participates in insurance and claims related conferences, meetings and functions to disseminate information regarding the agencys claims policies and practices; monitors issues or practices in the insurance industry which may impact claims services and operations, and recommends changes as needed; and acts as the director in their absence.

          DIRECTOR COMPENSATION CLAIMS & MEDICAL ADMINISTRATION: directs the claims and medical administration program; implements departmental policies, and develops long and short-term goals and objectives for the department in accordance with executive management and the Board of Commissioners directives; prepares the departmental budgets; evaluates performance of subordinates for compliance with established policies and objectives; establishes training programs, uniform claims and medical administration operating procedures, production goals, and quality standards for all claims functions within the Workers Compensation Law, the Volunteer Ambulance Workers Benefit Law, the Volunteer Firefighters Benefit Law, and the Disability Benefits Law; directs and monitors the effectiveness of the departments quality assurance program; advises executive management and Board of Commissioners on matters affecting claims and medical administration, as well as organizational problems and needs; keeps apprised of insurance industry trends impacting claims services and operations, and recommends department changes as needed; and represents the agency on various internal and external task forces and committees.

MINIMUM QUALIFICATIONS

ASSISTANT DIRECTOR COMPENSATION CLAIMS & MEDICAL ADMINISTRATION

Promotion: one year of service as a Claims Services Representative 3, Investigator 4 (Compensation Claims), or Chief Medical Care Representative.

DIRECTOR COMPENSATION CLAIMS & MEDICAL ADMINISTRATION

Promotion: one year of service as an Assistant Director Compensation Claims & Medical Administration.

Date:  8/16

NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe.  Standards cannot and do not include all of the work that might be appropriately performed by a class.  The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written.  Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.