Dedicated Account Workers' Compensation Adjuster (NY Claims)

Ccmsi • Wall Township, NJ

14d • Remote

About The Position

This role offers the opportunity to focus exclusively on New York Workers' Compensation claims within a dedicated client account supported by a highly collaborative team. You'll work alongside experienced professionals who value partnership, problem-solving, and quality claim handling over production quotas. This position handles complex lost-time claims, develops claim strategies, collaborates with clients and vendors, and drives timely, cost-effective claim resolution while supporting injured workers throughout the claim lifecycle. We are seeking an experienced Workers' Compensation Claim Consultant with a strong New York claims background to manage a complex caseload from inception through resolution. The ideal candidate brings at least five years of Workers' Compensation claims experience, possesses strong knowledge of New York Workers' Compensation laws and regulations, and thrives in a client-focused environment where quality claim outcomes, communication, and sound judgment are highly valued.

Requirements

• Minimum of five years of Workers' Compensation claims adjusting experience.
• Active New York Workers' Compensation Adjuster's License.
• Demonstrated experience handling New York lost-time and complex Workers' Compensation claims.
• Strong working knowledge of New York Workers' Compensation statutes, regulations, and claim procedures.
• Excellent investigation, negotiation, and analytical skills.
• Ability to independently manage a full claim caseload and drive claims to resolution.
• Proficiency with Microsoft Office products, including Word, Excel, and Outlook.

Nice To Haves

• Prior TPA experience.
• Experience handling litigated New York Workers' Compensation claims.
• Bilingual (Spanish) proficiency—highly valued for communicating with claimants, employers, providers, and vendors but this is NOT required

Responsibilities

• Investigate, evaluate, and adjust Workers' Compensation claims in accordance with New York Workers' Compensation laws, regulations, and CCMSI claim handling standards.
• Develop and execute strategic action plans for complex claims.
• Establish and manage reserves within established authority levels.
• Authorize and approve payments in accordance with claim handling procedures and authority guidelines.
• Evaluate medical, legal, vocational, and miscellaneous expenses for appropriateness and claim relevance.
• Coordinate and oversee defense counsel, nurse case management, IMEs, surveillance, and other vendors as appropriate.
• Negotiate settlements in accordance with client instructions, corporate standards, and applicable state regulations.
• Identify and pursue subrogation and recovery opportunities.
• Maintain proactive diary management and timely claim documentation.
• Prepare claim status reports, reserve analyses, and client communications.
• Compute disability benefits in accordance with New York Workers' Compensation requirements.
• Communicate effectively with clients, injured workers, employers, medical providers, attorneys, and other claim stakeholders.
• Participate in hearings, mediations, settlement conferences, and other claim-related proceedings as appropriate.
• Deliver exceptional client service while maintaining compliance with corporate claim handling standards and client-specific requirements.

Benefits

• 4 weeks (Paid time off that accrues throughout the year in accordance with company policy)
• 10 paid holidays in your first year
• Medical, Dental, Vision, Life, and Disability Insurance
• 401(k) and Employee Stock Ownership Plan (ESOP)
• Internal training and advancement opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed