Claims Examiner - Workers Compensation

Experis IT ManpowerGroup has partnered with a leading Insurance Co in the Syracuse NY area for a Claims Examiner - Workers Compensation role to assist their team. This is a Permanent (Direct Hire) role.

Industry: Insurance Co
Title: Claims Examiner - Workers Compensation
Location: ONSITE – Syracuse NY
Duration: Permanent (Direct Hire)
Pay: $80-$90k

Job Description

• Candidates must have at least two years of experience handling NY Workers’ Compensation lost time claims.
• Must hold a valid NY Adjusters’ License.

• Claims Analysis and Processing

• Analyze and process complex workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
• Manage claims through well-developed action plans to achieve appropriate and timely resolutions.

• Negotiation and Settlement

• Negotiate settlement of claims within designated authority.
• Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
• Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level.

• Regulatory Compliance

• Prepare necessary state filings within statutory limits.
• Manage the litigation process; ensure timely and cost-effective claims resolution.

• Vendor Coordination

• Coordinate vendor referrals for additional investigation and/or litigation management.
• Utilize appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall claims costs for clients.

• Claims Recovery Management

• Manage claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
• Report claims to the excess carrier; respond to requests for directions in a professional and timely manner.

• Communication and Documentation

• Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
• Ensure claim files are properly documented and claims coding is correct.
• Refer cases as appropriate to supervisor and management.
• Perform other duties as assigned.
• Support the organization's quality program(s).
• Travel as required.

• Education & Licensing

• Bachelor's degree from an accredited college or university preferred.
• Valid NY Adjuster's License required.

• Experience

• Three (3) years of claims management experience or an equivalent combination of education and experience required.

• Skills & Knowledge

• Subject matter expert in appropriate insurance principles and laws for the line-of-business handled, including recoveries, offsets, deductions, claim and disability duration, and cost containment principles.
• Excellent oral and written communication skills, including presentation skills.
• Proficient in PC applications, including Microsoft Office products.
• Strong analytical and interpretive skills.
• Excellent organizational and interpersonal skills.
• Exceptional negotiation skills.