Claims Examiner - Workers Compensation

Job Responsibilities

Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. Negotiates settlement of claims within designated authority. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level. Prepares necessary state filings within statutory limits. Manages the litigation process; ensures timely and cost effective claims resolution. Coordinates vendor referrals for additional investigation and/or litigation management. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner. Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. Ensures claim files are properly documented and claims coding is correct. Refers cases as appropriate to supervisor and management.

Requirements

Work Location: Yes we prefer Syracuse but we will consider remote Candidate must have a valid NY Adjuster's License Minimum 2 years of relevant experience handling NY Worker's Compensation lost time claims. Education & Licensing Bachelor's degree from an accredited college or university preferred. Candidate must have a valid NY Adjuster's License Three (3) years of claims management experience or equivalent combination of education and experience required.