Worker’s Compensation Claims Examiner

Worker’s Compensation Claims Examiner - Full-time

Location: Spring Valley, NY

Required Qualifications:

• Bachelor's degree.

• Professional designation such as CPCU, ARM, CRM, or similar.

• Proficient in Microsoft Office and adaptable to learn other software applications.

• Excellent oral and written communication skills.

• Detail-oriented with a high accuracy rate.

• Strong critical thinking and organizational skills.

• Ability to problem-solve and use good judgment.

• Self-motivated with excellent time management skills.

• 5+ years adjusting workers' compensation claims in multiple jurisdictions.

• Experience in NY, NJ, and PA preferred, with NY experience required.

• Healthcare industry experience.

• Construction industry experience.

• 5-7 years experience as a Workers Comp loss time claim adjuster.

Job Description

• Investigate and manage workers' compensation claims in multiple jurisdictions.

• Coordinate with nurse case managers, counsel, external vendors, and insureds for efficient claims handling.

• Complete and document initial loss investigations to determine compensability.

• Establish initial and subsequent reserves for anticipated exposure.

• Review medical bills for a causal relationship to reported claims.

• Liaison with insureds, nurse case managers, and counsel to oversee claim management and facilitate return to work.

• Develop and maintain action plans to ensure reserve adequacy and timely resolution of claims.

• Negotiate settlement of claims within designated authority.

• Prepare and present claim review summaries for insureds, brokers, and internal contacts as requested.

• Participate in discussions with insureds and counsel on strategies for successful claim closure.

• Provide guidance and assistance to insureds and brokers on timely reporting of claims.

• Manage insured onboarding, including training on claims reporting and use of the insured portal.

Benefits:

• Great work-life balance

• Market leader in commercial insurance and risk management

• Offer a wide range of career paths and opportunities for growth

• Competitive Compensation and Benefits: health insurance, retirement plans, and other benefits

Last updated on Aug 26, 2024