Worker’s Compensation Claims Examiner

FutureRecruit • Spring Valley, NY

13d

About The Position

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.

Requirements

• 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.
• NY experience required.
• Healthcare industry experience.
• Construction industry experience.
• 5-7 years experience as a Workers Comp loss time claim adjuster.

Nice To Haves

• Experience in NY, NJ, and PA preferred

Responsibilities

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level