Job Description

Workers’ Compensation Disability Claims Specialist – NY PPD/Pension

Job Summary

Seeking a detail-oriented Workers’ Compensation Disability Claims Specialist to manage and resolve indemnity claims for permanent partial disability (PPD) and pension cases in New York. Responsibilities include providing quality claims handling in accordance with regulations, policies, and best practices. Expertise in claims adjusting, compliance, and negotiation is required to deliver a positive claims experience for all stakeholders.

Responsibilities

• Manage a caseload of complex workers' compensation claims, focusing on NY PPD and pension claims.


• Evaluate claim information to determine liability, compensability, and appropriate benefit levels per New York Workers’ Compensation laws and regulations.


• Analyze medical reports, employment records, wage verification, and other relevant documentation to support claim decisions.


• Maintain communication with claimants, attorneys, medical professionals, and employers to ensure timely and accurate claim resolution.


• Calculate and process indemnity payments, settlements, and pensions per legal requirements and internal guidelines.


• Monitor changes in workers' compensation rules, case law, and employer policies for accurate claims handling.


• Negotiate settlements effectively and ethically, ensuring fair outcomes.


• Keep accurate and detailed files, documenting all claim activities in the claims management system.


• Assist claimants during the claims process, explaining policies and procedures.


• Collaborate with internal teams, such as legal and compliance, to address disputed or litigated claims.


• Identify opportunities for cost containment while committing to fair claim resolution.

Qualifications/Requirements

• Experience:
  
  
  
  • 3-5 years of experience as a Claims Adjuster, specifically in New York Workers’ Compensation claims.
  
  
  • Expertise in handling NY PPD and pension claims.
  
  
  
  


• Education: High school diploma or GED required; preferred college degree or industry certifications (e.g., AIC, CPCU).


• Knowledge:
  
  
  
  • Comprehensive understanding of New York Workers’ Compensation laws, regulations, and case law.
  
  
  • Familiarity with medical terminology, billing practices, and disability ratings.
  
  
  
  


• Skills:
  
  
  
  • Strong analytical and decision-making abilities.
  
  
  • Excellent verbal and written communication skills.
  
  
  • Proficiency with claims management systems and standard office software (e.g., MS Office Suite).
  
  
  
  


• Personal Attributes:
  
  
  
  • Detail-oriented, organized, and able to prioritize work in a fast-paced environment.
  
  
  • Customer-focused with a dedication to service excellence.
  
  
  • Capable of working independently while effectively collaborating with team members.
  
  
  
  


• Licenses/Certifications: Active New York Adjuster License or the ability to obtain one within a designated timeframe.

Disclaimer: Please note that this job description may not cover all duties, responsibilities, or aspects of the role, and it is subject to modification at the employer's discretion.

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