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Performs the initial review of claims for eligibility and/or compensation, with a focus on Eligibility Decisions and Non-Economic Loss Awards. Reviews claim file contents by checking the file against a checklist of documentation requirements. Reviews information submitted by claimants and performs analysis of claims to ascertain legal sufficiency. Identifies missing information and formulates appropriate requests to claimants or their counsel for additional submissions. Identifies areas requiring further review and/or additional information. Researches the appropriate mechanisms to perfect insufficient claims. Consults with and obtains guidance and approval by team leaders to resolve any questions or concerns that may arise regarding the appropriate determination on a claim. Applies appropriate discretion as circumscribed by, and in accordance with, established policies and standard operating procedures, demonstrating knowledge and understanding of policies and internal claim review guidance. Proactively communicates with claimants and claimants' attorneys to clarify issues relating to claims and ensures the complete information is provided. Provides guidance to claimants' legal representatives about VCF policies, procedures, and operations. Effectively manages queue to ensure prompt follow up on claims after required time period, prompt action on newly assigned claims, and to meet goals established for quantity and quality of claims produced. If asked about status of claim in queue by managers or VCF attorneys, is able to provide status of any claim in their queue. Accurately and completely documents activities and conversations in Claim Notes in accordance with VCF policy and effectively uses the Claims Management System for all aspects of claim review, including generating correspondence. Draft well-written and complete recommendations for the consideration of the Special Master about the appropriate disposition of claims, including the determination of Eligibility and the amount of Non-Economic Loss should be awarded.
Job Responsibility:
Performs the initial review of claims for eligibility and/or compensation, with a focus on Eligibility Decisions and Non-Economic Loss Awards
Reviews claim file contents by checking the file against a checklist of documentation requirements
Reviews information submitted by claimants and performs analysis of claims to ascertain legal sufficiency
Identifies missing information and formulates appropriate requests to claimants or their counsel for additional submissions
Identifies areas requiring further review and/or additional information
Researches the appropriate mechanisms to perfect insufficient claims
Consults with and obtains guidance and approval by team leaders to resolve any questions or concerns that may arise regarding the appropriate determination on a claim
Applies appropriate discretion as circumscribed by, and in accordance with, established policies and standard operating procedures, demonstrating knowledge and understanding of policies and internal claim review guidance
Proactively communicates with claimants and claimants' attorneys to clarify issues relating to claims and ensures the complete information is provided
Provides guidance to claimants' legal representatives about VCF policies, procedures, and operations
Effectively manages queue to ensure prompt follow up on claims after required time period, prompt action on newly assigned claims, and to meet goals established for quantity and quality of claims produced
If asked about status of claim in queue by managers or VCF attorneys, is able to provide status of any claim in their queue
Accurately and completely documents activities and conversations in Claim Notes in accordance with VCF policy and effectively uses the Claims Management System for all aspects of claim review, including generating correspondence
Draft well-written and complete recommendations for the consideration of the Special Master about the appropriate disposition of claims, including the determination of Eligibility and the amount of Non-Economic Loss should be awarded
Requirements:
Law degree, or currently attending an ABA-accredited law school, having completed at least one year of study or equivalent level of legal training or experience or an equivalent level of education may be substituted
Must be able to obtain and maintain MRPT facility credentials/authorization. Note: US Citizenship is required for MRPT facility credentials/authorization at this work location
Experience in government programs or litigation support preferred
Prior experience preferred in proven capabilities and communication skills to successfully interact with clients and attorneys
Experience in reviewing, evaluating, and analyzing claims, with the ability to apply established criteria to determine legal sufficiency
Experience in analyzing and organizing documents for supporting evidence and determining mechanisms to perfect insufficient claims
Strong organizational, communication, and interpersonal skills, including experience working with the public (claimants) and with external attorneys (claimants' legal representatives)
Excellent research and writing skills, demonstrated experience working with complex statutory and regulatory schemes, and flexibility and creativity in the application of existing policies
Excellent written and oral communication skills
Requires sound working knowledge of federal and state court systems, legal research procedures, and legal research resources, such as LexisNexis or Westlaw
Must have hands-on familiarity with a variety of computer applications, including word processing, databases (such as document review and file management systems), spreadsheets, and imaging
Strong Excel skills with experience using complex workbooks
Nice to have:
Experience in government programs or litigation support preferred
Prior experience preferred in proven capabilities and communication skills to successfully interact with clients and attorneys