Workers' Compensation Claims Examiner

This position is located in the Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), and can be assigned to a Workers' Compensation Claims Examiner in any of the four programs. The Division of Federal Employees' Compensation (DFEC), the Division of Longshore and Harbor Workers Compensation (DLHWC), the Division of Coal Mine Workers' Compensation (DCMWC) or the Division of Energy Employees Occupational Illness Compensation (DEEOIC).

Duties

-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.

Salary

• $50,460 - $73,142/year

Conditions of Employment

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

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.

Education Any applicant falsely claiming an academic degree from an accredited school will be subject to actions ranging from disqualification from federal employment to removal from federal service. If your education was completed at a foreign college or university, you must show comparability to education received in accredited educational institutions in the United States and comparability to applicable minimum coursework requirements for this position. Click Evaluation of Foreign Education for more information. Other Information Applicants must meet all legal and regulatory requirements. Reference the Required Documents section for additional requirements. The mission of the Department of Labor (DOL) is to protect the welfare of workers and job seekers, improve working conditions, expand high-quality employment opportunities, and assure work-related benefits and rights for all workers. Refer to these links for more information: GENERAL INFORMATION, REASONABLE ACCOMMODATIONS, ADDITIONAL DOCUMENTATION, FORMER FEDERAL EMPLOYEES As a condition of employment, all personnel must undergo a background investigation for access to DOL facilities, systems, information and/or classified materials before they can enter on duty: BACKGROUND INVESTIGATION This position is inside the bargaining unit. If the duty location is within the Washington, D.C. metropolitan area, the position will be included in the Local 12, AFGE bargaining unit. If the duty location is outside the Washington, D.C. metropolitan area, the position will be included in the NCFLL bargaining unit. For more information, click Career Ladder Promotion Information For more information, click Telework Position Information. This is not a remote work position. The selectee will report to an assigned DOL office location on a regular basis and is eligible for participation in telework as determined by management in accordance with DOL policy. Based on agency needs, additional positions may be filled using this vacancy. The Fair Chance Act (FCA) prohibits Federal agencies from requesting an applicant's criminal history information before the agency makes a conditional offer of employment. If you believe a DOL employee has violated your rights under the FCA, you may file a complaint of the alleged violation following our agency's complaint process Guidelines for Reporting Violations of the Fair Chance Act. Reasonable Accommodation (RA) Requests: If you believe you have a disability (i.e., physical or mental), covered by the Rehabilitation Act of 1973 as amended that would interfere with completing the USA Hire Competency Based Assessments, you will be granted the opportunity to request a RA in your online application. Requests for RA for the USA Hire Competency Based Assessments and appropriate supporting documentation for RA must be received prior to starting the USA Hire Competency Based Assessments. Decisions on requests for RA are made on a case-by-case basis. If you meet the minimum qualifications of the position, after notification of the adjudication of your request, you will receive an email invitation to complete the USA Hire Competency Based Assessments, based on your adjudication decision. You must complete all assessments within 48 hours of receiving the URL to access the USA Hire Competency Based Assessments if you received the link after the close of the announcement. To determine if you need a RA, please review the Procedures for Requesting a Reasonable Accommodation for Online Assessments. Required Documents

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

• Resumes: Required and applicants must provide a resume either by creating one in USAJOBS or uploading one from your 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.
• Veterans Documents (if applicable): To be considered as a 5-point (TP) preference eligible, you must submit a copy of your DD214, Certificate of Release or Discharge from Active Duty. Your DD 214 must show the type of discharge and dates of active duty. To claim 10-point (CP/CPS, XP) preference, you must submit a copy of your DD214 and the proof of entitlement of this preference, which is normally an official statement, dated 1991 or later, from the Department of Veterans Affairs certifying to the present existence of the service-connected disability and indicating the percentage of your disability. In addition, a Standard Form (SF-15) should be included, but is not required. (For active-duty service members expecting honorable or general discharge or release within 120 days, click Tentative Preference for Active Duty). For more information, go to Feds Hire Vets - Veterans Preference.
• Displaced Employee Placement Documents: Only required if requesting priority consideration under CTAP or ICTAP eligibility.
• 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, PhD, 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.

Cover Letters are not mandatory and will not be used to verify experience but may be submitted.

Do not upload password-protected documents.

NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.
For more detailed information on applying for positions with DOL click here to view the U.S. Department of Labor, How to Apply website.

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.

How to Apply

Persons who are deaf, hard of hearing, blind, or have speech disabilities, please dial 711 to access telecommunications relay services.

To apply for this position, you must complete the initial online application, including submission of the required documentation specified in the Required Documents section.

Your application and ALL required supplemental documents MUST be received by 11:59 pm Eastern Time on the vacancy closing date to receive consideration.

Important - Save your information before the 30-minute system timeout! For help, go to the USAJOBS Help Center.

STEP 1 - Create USAJOBS Account on www.usajobs.gov, including Resume and Saved Documents. For each employment period, include start/end month & year and note full-time or part-time (if part-time, include # of hours worked per week) otherwise, your application may be considered incomplete.

NOTE: In alignment with the Presidential Memorandum titled Merit Hiring Plan, dated May 29, 2025, applicants may only submit a resume limited to two (2) pages. Only the résumé uploaded under the 'Resume" document type in USAJOBS will be reviewed. If the resume submitted exceeds two (2) pages, the application will be deemed ineligible for further consideration.

STEP 2 - Complete the 1st part of the application process (USAJOBS). Once you have identified a job on USAJOBS that you wish to apply for, click on the job title and then click the Apply button. For questions about the vacancy, contact the Agency Contact at the bottom of the announcement. Proceed through the steps noted at the top of the USAJOBS page. You will be able to select a resume and documents from your USAJOBS Account that you can submit as a package as part of your DOL application. In the final step, once you have certified your application, click the Continue to agency site button.

STEP 3 - Complete the 2nd part of the application process (DOL). On the Department of Labor (DOL) page, create a DOL Account if you have not already and click Apply to this vacancy. Continue through the progress steps at the top of the DOL page. The 2nd progress step is where you answer the vacancy-specific questions. The 3rd progress step Documents is where you submit the required documents (only if applicable to you) specified in the Required Documents section of this vacancy.

STEP 4 - On the Review and Submit step, verify each section of your application is complete and correct. In order to submit your application, you must have a check mark next to each section listed. If there is an X, return to the appropriate section and follow the prompts. When it is ready for submission, certify your application and click the Submit Application button.

STEP 5 - Edit Application as needed by 11:59 pm Eastern Time of Closing Date by returning to USAJOBS, clicking the vacancy, thenUpdate Application.

If you are required to complete any USA Hire Assessments, you will be notified after submitting your application. The notification will be provided in your application submission screen and via email. The notification will include your unique assessment access link to the USA Hire system and the completion deadline. Additionally, in USAJOBS you can click "Track this application" to return to your assessment completion notice.

• Access USA Hire using your unique assessment link. Access is granted through your USAJOBS login credentials.
• Review all instructions prior to beginning your assessments. You will have the opportunity to request a testing accommodation before beginning the assessments should you have a disability covered under the Rehabilitation Act of 1973 as amended.
• Set aside about 2 Hours to take the USA Hire Assessment; however, most applicants complete the assessments in less time. If you need to stop the assessments and continue later, you can re-use your unique assessment link.
• Your responses to the USA Hire Assessments will be reused for one year (in most cases) from the date you complete an assessment. If future applications you submit require completion of the same assessments, your responses will be automatically reused.

Visit the USA Hire Applicant Resource Center for practice assessments and assessment preparation resources at https://support-usahire.opm.gov/hc/en-us.

To update your application, including supporting documentation: During the announcement open period, return to your USAJOBS account, find your application record, and click Edit my application. This option will no longer be available once the announcement has closed.

To view the announcement status or your application status: Visit https://www.usajobs.gov/Help/howto/application/status/. Your application status page is where you can view your application status, USA Hire assessment completion status, and review your notifications sent by the hiring agency regarding your application.