Claims Specialist I

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Annual Salary Range:
$28,716.00 – $39,984.00
Twice-a-Month Salary Range:
$1,196.50 – $1,666.00
Class Number: 
0781
Pay Grade: 
A17
Areas of Interest: 
Business Services; College Graduates
Exam Components: 
Written Examination, 100%
Definition

This is technical interviewing and related work in the unemployment insurance benefit/claims program of the Missouri Division of Employment Security.

This description may not include all of the duties, knowledge, skills, or abilities associated with this classification.
Examples of Work

Secures and evaluates information required to process state and federal unemployment insurance claims, shared work claims, and claims for training, subsistence, and transportation allowances under various employability programs.

Performs work in the Regional Claims Centers or the Central Office of the Division of Employment Security.

Secures detailed information from claimants and enters that data into the computer system; determines the type of unemployment claim to be filed under the various state and federal unemployment insurance programs.

Secures, documents, and investigates detailed and sensitive information from claimants involved in disputed claims, including such complicated issues as separation from work, availability for work, refusal of work, participation in a labor dispute, and overpayment investigations.

Secures and documents additional technical information from employers and other interested parties by means of telephone interviews and correspondence to obtain complete facts of the issues involved.

Obtains facts and issues determinations relevant to a trainee’s eligibility status for federal allowance payments under the various employability programs.

Evaluates information secured, applies proper section of the law to the facts, and prepares non-monetary determinations for forwarding to all interested parties.

Reviews and evaluates new information received after a determination has been issued to determine if the proper course of action is to process an appeal or reconsider a determination.

Interviews claimants to secure information concerning previous wages earned and weeks worked for use in determining additional wage credits to which they may be entitled or for the overpayment of benefits.

Corresponds and communicates with claimants, employers, Central Office, and state and federal agencies to correct errors, resolve problems, and facilitate the processing of claims.

Receives and answers telephone and written inquiries regarding unemployment insurance.

Establishes, maintains, and purges files on disputed claims to ensure prompt processing.

Directs the conversion to electronic documents of all mail and fax correspondence for Regional Claims Centers.

Attends various training sessions and meetings to remain aware of program procedures and law changes.

Studies new and revised agency procedures, rules, laws, regulations, and other program changes contained in operating manuals to maintain currency of knowledge and information.

Applies established procedures for control of overpayment and fraud on all types of claims.

Receives assignments in cases of potential overpayment of erroneous or fraudulent claims; collects and evaluates information; and establishes facts and makes recommendations and determinations consistent with law.

Interviews claimants with outstanding overpayments and arranges for restitution.

Communicates with financial institutions to resolve complex cases involving lost/stolen/forged checks, direct deposits, or debit card payments on unemployment claims.

Receives moderate supervision; however, the employee is expected to exercise independent judgment and initiative within the framework of established state and federal laws and agency policies and procedures.

Performs other related work as assigned.

Knowledge, Skills, and Abilities (KSAs)

Introductory knowledge of interviewing and investigative techniques and procedures required in the processing of claims for unemployment insurance.

Introductory knowledge of the principles, objectives, and regulations underlying the unemployment insurance program and of the applicable state and federal laws.

Introductory knowledge of current office procedures, practices, and equipment.

Introductory knowledge of computer and related equipment for data input, retrieval, and word processing.

Ability to obtain and document essential facts clearly and concisely, evaluate information, and make determinations on the basis of established rules and precedents.

Ability to communicate effectively with agency staff, claimants, employers, and other persons.

Ability to work rapidly and accurately.

Ability to establish and maintain effective working relationships with claimants, employers, and coworkers.

Experience and Education

(The following requirements will determine merit system eligibility, experience and education ratings, and may be used to evaluate applicants for Missouri Uniform Classification and Pay System positions not requiring selection from merit registers.  When practical and possible, the Division of Personnel will accept substitution of experience and education on a year-for-year basis.)

Two or more years of experience as a Claims Examiner or Contributions Examiner with the Missouri Division of Employment Security; and possession of a high school diploma or proof of high school equivalency.

OR 

A Bachelor’s degree from an accredited college or university with a minimum of 15 earned credit hours in one or a combination of the following:  social sciences, Education, or Public or Business Administration. 

(Technical experience in the fields of social services, social welfare, education, community organization; business, personnel, or public administration involving public contact, or a closely related field; or clerical experience with the Missouri Division of Employment Security at or above the Senior Office Support Assistant level may substitute on a year-for-year basis for deficiencies in the required college education.)

(Minor Revision 11/1/13)