Claims Examiner | WC | NY License

Title:  Claims’ Adjuster – Workers’ Compensation
Work Status: 100% Remote – 
Geographical Preference – Eastern or Central Time Zone

Workers’ Compensation Claims’ Professionals who will be the handle NY  Loss Time Claims   Ideal candidate will have min. 3+ years of lost time claims’ handling experience. MUST possess and active NY License.  Senior Loss Time opportunities also available with Min 5+ years experience.

General Description:

Manage within company standards and best practices complex and problematic high visibility workers’ compensation claims within delegated limited authority to determine benefits due, work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer requirements to achieve the best possible outcome in the claim.

Essential Job Duties:

1. Receives claim, confirms policy coverage & acknowledgement of claim
2. Determine validity & compensability of claim by investigating & gathering infor, file necessary documentation with state agencies
3. Establish reserves & authorize payments within reserving authority limits
4. Develop and manage well documented action plan with case manager, attorney, supervisor & client to reduce overall cost of claim
5. Coordinating early return to work efforts with case manager & employer
6. Negotiates settlements when necessary
7. Actively manage the litigation process
8. Identifies potential subrogation claims
9. Communicate claim status with customer and claimant
10. Adhere to client guidelines & participate in claim reviews as needed
11. Develops & maintains professional customer relationships

Education/Training Requirements:

1. Degree at an accredited college or university preferred
2. Three years handling claims WC Lost Time 
3. Excellent oral, written communication skills & customer service
4. PC literate, including Microsoft Office (Word, Excel)
5. Effective analytical & interpretive skills
6. Strong organizational skills
7. Great interpersonal skills

Related Opportunities – Claims Supervisor (required NY License and strong Jurisdictional  exposure