Claims Liability Adjuster (Remote)

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Full Time Bohemia, NY, US

Jones Jones LLC is a trusted leader in workers’ compensation defense, claims management, and regulatory compliance. With decades of industry experience, we proudly serve clients through our affiliated entities - NYTIC, Emerald, Mediation Resolution Management, and Medical Management Group - offering innovative solutions, collaborative teamwork, and unwavering professionalism. We are seeking an experienced Claims Adjuster/Examiner who is interested in growing and expanding their expertise across multiple entities, including NYTIC, Emerald, Mediation Resolution Management and Medical Management Group. This unique cross-functional role offers exposure to complex claims, compliance, and ADR operation. This is a 100% fully remote position.

Conduct compensability analysis and develop action plans

Ensure timely filings: employer first report, EDI FROI/SROI via Emerald, PH-16.2, and C-240 wage statement

Monitor treatment against NY Medical Treatment Guidelines; Route medical bills to bill review and ensure fee schedule compliance

Collaborate with the Compliance team on licensing forms and regulatory filings

Support examiner training and respond to licensing-related inquiries

ADR (MRM)

Manage intake, eligibility, and notices under the collectively bargained ADR program

Ensure adherence to Medical Network protocols and document variances

Maintain dashboards of ADR cycle times and outcomes for annual reporting

Evaluate Independent Medical Examination (IME) reports for accuracy and compliance

Assist with administrative tasks such as schedule coordination and provider panel management

Proficient with Microsoft Office Suite or related software

Bachelor’s degree in business administration or related field

3 - 5 years of claims management experience

Must have EDI filing experience