Workers Compensation Claims Specialist

Job Description

Job Description

3-6 month C2H / 40hr / Queens, NY

Seeking a Workers' Compensation PPD Claims Examiner to manage classified Permanent Partial Disability (PPD) claims and support active workers' compensation caseloads. This role is responsible for claim resolution, settlement negotiations, reserve management, regulatory compliance, medical oversight, and communication with claimants, attorneys, management, and excess carriers.

Key Responsibilities

• Manage and review classified PPD claims through settlement and closure.
• Negotiate Section 32 settlements with attorneys, subject to management approval.
• Maintain claim reserves and provide status updates to management and excess carriers.
• Conduct periodic claimant "alive and well" reviews and coordinate follow-up investigations when necessary.
• Process claim payments and maintain accurate claim documentation.
• Coordinate medical treatment, IMEs, investigations, and disability evaluations.
• Ensure timely filing of all NYS Workers' Compensation forms and compliance with applicable regulations.
• Analyze claim exposure, compensability, and settlement value.
• Serve as backup examiner for active workers' compensation claims.
• Maintain professional relationships with claimants, attorneys, medical providers, and vendors.

Qualifications

• Minimum 1+ year of New York Workers' Compensation claims experience required.
• Strong knowledge of NYS Workers' Compensation and Disability laws.
• Experience handling claim reserves, indemnity benefits, and medical management.
• Familiarity with NYS Workers' Compensation forms and claims administration processes.
• Strong analytical, communication, organizational, and decision-making skills.
• Proficiency in Microsoft Word and Excel.
• Ability to work independently while collaborating effectively with a team.
• Bachelor's degree preferred or equivalent combination of education and experience.
• Commitment to confidentiality and professional judgment.

\nCompany Description

Top Prospect Group founders and management team offer more than 25 years
of experience in Information Technology and Creative Staffing. Our fundamental goal is to build successful relationships resulting in accurate job and prospect representations. Top Prospect Group meets with those we work with face-to-face to garner a better understanding of candidate or client requirements. By leveraging our experience and market insight, we are then able to provide a more consistent recruitment process.

Company Description

Top Prospect Group founders and management team offer more than 25 years\r\n of experience in Information Technology and Creative Staffing. Our fundamental goal is to build successful relationships resulting in accurate job and prospect representations. Top Prospect Group meets with those we work with face-to-face to garner a better understanding of candidate or client requirements. By leveraging our experience and market insight, we are then able to provide a more consistent recruitment process.