Senior Work Comp Claims Adjuster II - New York

100% Remote (WFH) Opportunity

General Summary

With minimal oversight, the Senior Workers Compensation Claims Adjuster II is responsible for timely and accurate management of workers’ compensation claims with high or catastrophic medical and indemnity benefits, involving litigation and complex issues and exposures.

Must have 10+ years of experience adjusting work comp claims for a TPA/Carrier in the state of New York

Essential Duties and Responsibilities

• Completes initial contacts to obtain necessary information, verify coverage, determine compensability and develop a plan of action as it pertains to work comp claims.
• Completes and maintains workers' compensation claim data integrity.
• Independently analyzes case facts to establish timely and accurate reserves using knowledge and experience with medical disabilities and related costs, as well as judgment of extent of disability.
• Collaborates with Corporate Claims to proactively evaluate and mitigate high exposure, serious or catastrophic workers' compensation losses.
• Provides timely and appropriate customer service within established best practices.
• Maintains ongoing professional communications with all internal and external customers.
• Accurately evaluates and pays benefits in compliance with statutory and company procedures and guidelines.
• Files appropriate state forms, as needed.
• Proactively manages or coordinates medical treatment to continue to move the claim forward.
• Uses internal and external resources to contain costs and manage exposure.
• Reviews and analyzes litigation and legal issues. Directs legal strategy and participates in preparation of the case for litigation.
• Collaborates with defense attorney to move claims to resolution.
• Completes detailed settlement analysis and recommends appropriate settlement value, utilizing in-depth knowledge of appropriate workers’ compensation insurance principles and laws, subrogation recoveries, offsets and deductions, claim and disability duration, cost containment principles; including medical management practices and Social Security and Medicare application procedure as applicable.
• Regularly reviews caseload and proactively takes action to guide claims efficiently and effectively to closure. Uses a high degree of independent judgment to render accurate decisions.
• Mentors other team members and acts as a Subject Matter Expert for legal, jurisdiction and Company needs. May handle supervisory duties, as needed.

Requirements

• 10 or more years of workers’ compensation insurance claims experience including complex claims handling.
• Superior communication and customer service skills and proficiency in an imaged environment.
• Demonstrated knowledge of workers’ compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols.
• Self-motivated with the ability to work independently with minimal direction. The ability to multi-task and prioritize, adhere to deadlines and complete assignments accordingly.
• Excellent analytical, problem solving and decision-making skills.

Certification

If state insurance certification or license is required, must meet certification within state mandated timeframe and maintain any required license through continuing education. WCCP, AIC, ARM, CPCU or other insurance designation is preferred.

Education

Bachelor’s degree or equivalent business experience preferred.

Work Environment:

Remote: This role is a remote (work from home (WFH) opportunity, and only open to candidates currently located in the United States and able to work without sponsorship. It requires a suitable space that provides a private and quiet workplace.

Expected Work Hours:

Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

Travel:

May be required to travel to off-site location(s) to attend meetings, as necessary.

Salary Range:

$80,000 - $120,000 and a comprehensive benefits package, please follow the link to our benefits page for details!