Medical Records Examiner

Job Description

Commonwealth of PA - Opportunities for All Job Seekers | Find Your Passion for Public Service! Opens in a new window Opens an external website Opens an external website in a new window Accept Deny Non-Essential Manage Preferences Close Cookie Preferences For full functionality of this page it is necessary to enable JavaScript. Here are the instructions how to enable JavaScript in your web browser Medical Records Examiner | Find Your Passion for Public Service! page has loaded. Medical Records Examiner | Find Your Passion for Public Service! page has loaded. Skip to main content Click here or press any key to continue. Commonwealth of PA - Opportunities for All Job Seekers Menu Commonwealth of PA - Opportunities for All Job Seekers Sign In Saving... Account could not be created. Please fix the errors to continue. Sign In All fields are required Create an account Username or Email Password Sign In Forgot username | Reset password Sign in with GoogleSign in with Google. Opens in new tab Facebook Don't have an account? Create one. Already have an account? Sign In. User profile dropdown menu for Username Applications Inbox Profile Account Sign Out After clicking on this link you will be logged out and the page will be reloaded. Applications Inbox Profile Go to Background Investigation Account Sign Out After clicking on this link you will be logged out and the page will be reloaded. Welcome! Thanks for creating an account. Find Your Passion for Public Service! powered by NEOGOV ® Medical Records Examiner Print Apply  Medical Records Examiner Salary $67,736.00 - $102,905.00 Annually Location Lackawanna County, PA Job Type Civil Service Permanent Full-Time Job Number CS-2026-40157-39570 Department Department of Labor & Industry Division LI SWIF Clm Serv Div Opening Date 01/12/2026 Closing Date 1/25/2026 11:59 PM Eastern Job Code 39570 Position Number 00155098 Union FOP Lodge 92 Bargaining Unit G4 Pay Group ST08 Bureau / Division Code 00121640 Bureau / Division SWIF Claims Services Division Worksite Address Scranton State Office Building Worksite Address 100 Lackawanna Avenue City Scranton, Pennsylvania Zip Code 18503 Contact Name Felicia Newbury Contact Email fnewbury@pa.gov Description Benefits Questions THE POSITION Are you a detail-oriented healthcare professional who enjoys analyzing complex medical records and documentation? If so, consider starting a new chapter in your career with the Department of Labor and Industry as a Medical Records Examiner. In this position, you will play a key role in determining appropriateness of medical treatment and its conformity with the Pennsylvania Workers' Compensation Act. If you have a knack for spotting inconsistencies and ensuring accuracy, we have the perfect opportunity for you! DESCRIPTION OF WORK As a Medical Records Examiner, you will be responsible for conducting utilization reviews. This involves evaluating medical information, records, and reports to assess the necessity and appropriateness of care and services provided to State Workers' Insurance Fund (SWIF) covered individuals. Work also includes assessing care or treatment plans; providing authorization for services, medications, or durable medical equipment; and verifying codes associated with claims, determining which diagnoses are related to the work injury. You will have the opportunity to network with other SWIF divisions such as claims services, legal, and fraud as well as external organizations such as pharmacy benefit managers, contractors, and third-party administrators. Additional responsibilities include:Reviewing medical bills to evaluate compensability of services and appropriate payment amountsMonitoring medical management reports and nursing care plansProviding assistance and direction to field office staffUtilizing standard office applications and SWIF specific systems, such as the Workers' Compensation Automation and Integration System (WCAIS)Interested in learning more? Additional details regarding this position can be found in the position description.Work Schedule and Additional Information:Full-time employmentWork hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.Telework: You may have the opportunity to work from home (telework) part-time. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Scranton. The ability to telework is subject to change at any time. Additional details may be provided during the interview.Salary: In some cases, the starting salary may be non-negotiable. You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices. REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY QUALIFICATIONSMinimu