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Sr. Work Comp Claims Adjuster for New York Claims
New York, New YorkJob Opening: Senior Work Comp Claims Adjuster (New York jurisdiction)
Location: Offering Remote if desired
Status: Exempt
POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
DUTIES AND RESPONSIBILITIES:
EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer, and other office equipment.
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:
Other Qualifications:
Location: Offering Remote if desired
Status: Exempt
POSITION SUMMARY: Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.
DUTIES AND RESPONSIBILITIES:
- Adjuster will work remotely from home, if desired remote
- Effectively manages a caseload of 100 to 125 workers’ compensation files, including very complex claims.
- Jurisdiction is NY.
- Initiates and conducts investigation in a timely manner.
- Determines compensability of claims and administer 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 set reserves within Company guidelines. Limits are larger than those allowed for Claims Adjuster I and Claims Adjuster II.
- Settles and/or finalize 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 COMPANY loss control staff when appropriate
- Adheres to all Company policies and procedures
- Conducts file reviews independently
- Other duties as assigned.
EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer, and other office equipment.
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:
- Valid New York state adjuster license required