Sr Claim Examiner- WC

Crawford•Hauppauge, NY

11d•Remote

About The Position

Investigates and settles advanced, large-loss, and complex workers’ compensation claims promptly and equitably under minimal supervision. Works within established authority on moderate-to-difficult claims by reviewing coverage, determining liability and compensability, securing information, arranging property damage appraisals, and settling claims using claims best practices. Evaluates and sets reserves using independent judgment. Assists supervisors and company attorneys in preparing cases for litigation, and conducts training and mentors new hires.

Requirements

Bachelor’s degree or equivalent experience.
Four to eight years of technical claims investigation and settlement experience in Claims or a similar organization.
Workers’ Compensation (WC) Adjuster License, as required by jurisdiction.
Ability to work independently while assimilating various technical subjects.
Strong written and oral communication, negotiation, and presentation skills.
Advanced analytical and problem-solving skills, including the ability to manage and prioritize multiple projects.
Advanced interpersonal skills to interact effectively with internal and external clients at all levels.

Nice To Haves

Industry designations preferred but not required, such as IIA, AIC, AEI, and/or CPCU.

Responsibilities

Interpret policy coverage and independently determine whether coverage applies to submitted claims, including complex and unusual coverage issues.
Manage all aspects of investigative activity on complex claims.
Direct discovery and litigation strategy with legal counsel.
Analyze claim activity and prepare reports for clients, carriers, and management.
Establish reserves using independent judgment and expertise, and authorize payments within scope of authority.
Settle claims cost-effectively, promptly, and equitably; issue company drafts and ensure timely disbursement of payments within authority limits.
Develop subrogation and third-party recovery opportunities and follow reclaim procedures.
Participate in claim reviews.
Assist supervisors and company attorneys in preparing cases for litigation.
Conduct training and mentor new hires.