Workers Compensation Claims Examiner

Worker’s Compensation Claims Examiner - Full-time

Location: Spring Valley, NY

Required Qualifications:

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  Bachelor's degree.

  
  


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  Professional designation such as CPCU, ARM, CRM, or similar.

  
  


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  Proficient in Microsoft Office and adaptable to learn other software applications.

  
  


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  Excellent oral and written communication skills.

  
  


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  Detail-oriented with a high accuracy rate.

  
  


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  Strong critical thinking and organizational skills.

  
  


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  Ability to problem-solve and use good judgment.

  
  


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  Self-motivated with excellent time management skills.

  
  


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  5+ years adjusting workers' compensation claims in multiple jurisdictions.

  
  


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  Experience in NY, NJ, and PA preferred, with NY experience required.

  
  


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  Healthcare industry experience.

  
  


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  Construction industry experience.

  
  


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  5-7 years experience as a Workers Comp loss time claim adjuster.

  
  

Job Description

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  Investigate and manage workers' compensation claims in multiple jurisdictions.

  
  


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  Coordinate with nurse case managers, counsel, external vendors, and insureds for efficient claims handling.

  
  


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  Complete and document initial loss investigations to determine compensability.

  
  


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  Establish initial and subsequent reserves for anticipated exposure.

  
  


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  Review medical bills for a causal relationship to reported claims.

  
  


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  Liaison with insureds, nurse case managers, and counsel to oversee claim management and facilitate return to work.

  
  


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  Develop and maintain action plans to ensure reserve adequacy and timely resolution of claims.

  
  


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  Negotiate settlement of claims within designated authority.

  
  


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  Prepare and present claim review summaries for insureds, brokers, and internal contacts as requested.

  
  


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  Participate in discussions with insureds and counsel on strategies for successful claim closure.

  
  


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  Provide guidance and assistance to insureds and brokers on timely reporting of claims.

  
  


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  Manage insured onboarding, including training on claims reporting and use of the insured portal.

  
  

Benefits:

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  Great work-life balance

  
  


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  Market leader in commercial insurance and risk management

  
  


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  Offer a wide range of career paths and opportunities for growth

  
  


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  Competitive Compensation and Benefits: health insurance, retirement plans, and other benefits