Workers Compensation Claims Examiner III _ New York

Workers Compensation Claims Examiner III _ New York

Fully remote or hybrid in Philadelphia, PA 19107

Salary Range $75,000.00 - $85,000.00 per year

Position Type: Full Time

Education Level: High School Diploma or GED

Category: Insurance

Position Summary: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.

This is a full-time position that requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.

Duties and Responsibilities:

• Adjuster will work remotely from home
• Effectively manages a caseload of 100 to 125 workers' compensation files, including very complex claims.
• Jurisdiction is NY.
• Initiates and conducts investigations in a timely manner.
• Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company guidelines.
• Manages medical treatment and medical billing, authorizing as appropriate.
• Refers cases to outside defense counsel. Directs and manages as appropriate.
• Communicates with claimants, providers, and vendors regarding claims issues.
• Computes and sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.
• Settles and/or finalizes all claims and obtains authority as designated.
• Maintains diary system for case review and documents file to reflect the status and work being performed on the file.
• Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.
• Involves TRISTAR loss control staff when appropriate.
• Adheres to all Company policies and procedures.
• Conduct file reviews independently.
• Other duties as assigned.

Equipment Operated/Used: Computer, fax machine, copier, printer, and other office equipment.

Special Equipment or Clothing: Appropriate business casual office attire

Qualifications Required:

Education/Experience: Bachelor's degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience.

Knowledge, Skills and Abilities:

• Technical knowledge of statutory regulations and medical terminology.
• Analytical skills.
• Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff.
• Ability to interact with persons at all levels in the business environment.
• Ability to independently and effectively manage very complex claims.
• Proficient in Word and Excel (preferred).

Other Qualifications:

• Must have a valid New York state adjuster license

Here are some of the benefits you can enjoy in this role:

• Medical, Dental, Vision, Life Insurance & Disability
• 401 k plan
• Paid time off
• Paid holidays