State of Maryland

A Claims & Benefits Specialist III is the full performance level of work examining claims and assisting with technical and financial eligibility determinations for claims in accordance with program policies and State regulations in the Division of Family and Medical Leave Insurance, Maryland Department of Labor. Employees in this classification do not supervise other positions.

Employees in this classification receive general supervision from a FAMLI Claims & Benefits Supervisor, FAMLI Claims & Benefits Manager, or other designated program administrator.

Position placement in this classification is determined by the Classification Job Evaluation Methodology. The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of a classification specification.

The Claims & Benefits Specialist I, Claims & Benefits Specialist II, and the Claims & Benefits Specialist III are differentiated on the basis of supervisory control exercised by the supervisor over these employees. The Claims & Benefits Specialist I learns to perform duties under close supervision, the Claims & Benefits Specialist II performs the duties under close supervision at times and under general supervision at other times, depending on the complexity of the specific duty being performed, and the Claims & Benefits Specialist III performs the full range of duties under general supervision.

Reviews accuracy of and resolves issues with claims and/or benefits issuance;

Analyzes claims to recommend eligibility using knowledge of program policies, procedures, and regulations;

Researches and gathers information for outstanding issues on claims and/or benefits issuance;

Conducts fact-finding interviews with claimants and other stakeholders;

Identifies potentially disqualifying issues in claimants’ benefits eligibility;

Escalates questionable and/or fraudulent claims;

Addresses and researches customer concerns involving claims and benefits escalated from the Customer Care team;

May perform claims intake and processing;

May coordinate or assist with referrals for claim overpayments, reconsiderations, and appeals;

May assist the Customer Care team by answering phone calls, emails, and/or chats from claimants and employers;

Performs other related duties.

Knowledge of State family and medical leave laws, rules, and regulations;

Skill in communicating effectively with a diverse range of clients both verbally and in writing;

Skill in the use of standard office equipment, such as photocopiers, calculators, personal computers, and printers;

Ability to exercise sound and impartial judgment in analyzing facts and evidence, evaluating such information, and drawing valid conclusions from documentary evidence in making sound decisions;

Ability to establish and maintain effective and harmonious working relationships with the general public, employers, healthcare professionals, and co-workers;

Ability to organize daily work plans;

Ability to learn and apply new computer applications and computer systems;

Ability to apply State family and medical leave laws, rules, and regulations and make appropriate recommendations;

Ability to work independently and as part of a team.

Education: Graduation from a high school or possession of a high school equivalency certificate.

Experience: Five (5) years of experience in public contact, including explaining information, gathering and compiling data, performing analysis of data, or completing general administrative tasks.

Notes:

1. Candidates may substitute the possession of a Bachelor's degree from an accredited four-year college or university for four (4) years of required experience.

2. Candidates may substitute additional college education at an accredited college or university at the rate of thirty (30) credit hours for one (1) year of the required experience.

Class specifications are broad descriptions covering groups of positions used by various State departments and agencies. Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

This is a Skilled Service classification in the State Personnel Management System. All positions in this classification are Skilled Service positions. Some positions in Skilled Service classifications may be designated Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is assigned to Bargaining Unit G, Engineering, Scientific, and Administrative Professionals classes. As provided by the State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial, and confidential employees are excluded from collective bargaining. Additionally, certain executive branch agencies are exempt from collective bargaining, and all positions in those agencies are excluded from collective bargaining.

This classification is one level in a Non-Competitive Promotion (NCP) series. NCP promotions are promotions by which employees may advance in grade and class level from trainee to full performance level in a classification series. In order to be non-competitively promoted to the next level in an NCP series, an employee must: 1) perform the main purpose of the class, as defined by the Nature of Work section of the class specification; 2) receive the type of supervision defined in the class specification; and 3) meet the minimum qualifications of the classification.