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Worker's Compensation Claims Examiner

FutureRecruit
Spring, NY Full Time
POSTED ON 1/14/2025
AVAILABLE BEFORE 4/10/2025

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

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