Senior Workers' Compensation Claims Examiner | Remote

King'S Insurance Staffing•Philadelphia, NY

2d•Remote

About The Position

Our client is seeking an experienced Senior Workers' Compensation Claims Examiner to join a growing claims operation. This role is suited to a knowledgeable claims professional with extensive experience handling New York Workers' Compensation claims and independently managing complex indemnity files. The examiner oversees claims throughout their lifecycle, applying sound judgment, investigative skills, and a thorough understanding of New York Workers' Compensation regulations. The role works closely with injured employees, medical professionals, legal representatives, and other stakeholders to ensure claims are handled accurately, efficiently, and in compliance with applicable requirements. The position manages a portfolio of approximately 100–105 Workers' Compensation claims, including complex and high-exposure indemnity cases. The salary range is $90,000–$105,000, depending on experience. The role offers a flexible work schedule and comprehensive medical, dental, and vision insurance, a 401(k) retirement savings plan with potential employer contributions, paid time off, vacation, and company-observed holidays.

Requirements

At least 4 years of experience managing New York Workers' Compensation claims, including indemnity and complex claim exposures.
Demonstrated experience handling New York Workers' Compensation claims.
Active New York claims handling license.
Strong working knowledge of New York Workers' Compensation statutes, claims procedures, and regulatory requirements.
Experience evaluating compensability, managing medical treatment, establishing reserves, and negotiating settlements.
Ability to independently manage a substantial claims inventory while maintaining accuracy and meeting established deadlines.
Experience coordinating with defense counsel and overseeing litigated claims.

Responsibilities

Independently oversee a portfolio of approximately 100–105 Workers' Compensation claims, including complex and high-exposure indemnity cases.
Evaluate newly reported claims, gather relevant information, and establish appropriate strategies for resolution.
Review medical documentation, employment information, and investigative findings to determine claim eligibility and appropriate benefits.
Ensure claims decisions and benefit payments comply with New York Workers' Compensation laws and regulatory requirements.
Coordinate medical care, review treatment requests, and address billing matters.
Evaluate compensability, manage medical treatment, establish reserves, and negotiate settlements.
Coordinate with defense counsel and oversee litigated claims.
Work with injured employees, medical professionals, legal representatives, and other stakeholders to handle claims accurately and efficiently.