Experis
Claims Examiner - Workers Compensation
Experis, Syracuse, New York, us, 13235
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 CoTitle:
Claims Examiner - Workers CompensationLocation: ONSITE - Syracuse NYDuration:
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.
To analyze complex or technically difficult workers' compensation claims to determine benefits due. This role involves managing high-exposure claims that may involve litigation and rehabilitation, ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Additionally, the position includes identifying subrogation opportunities and negotiating settlements.
What You'll Do
Claims Analysis and ProcessingAnalyze 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 SettlementNegotiate 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 CompliancePrepare necessary state filings within statutory limits.Manage the litigation process; ensure timely and cost-effective claims resolution.Vendor CoordinationCoordinate 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 ManagementManage 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 DocumentationCommunicate 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.You will need to have:
Education & LicensingBachelor's degree from an accredited college or university preferred.Valid NY Adjuster's License required.ExperienceThree (3) years of claims management experience or an equivalent combination of education and experience required.Skills & KnowledgeSubject 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.
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 CoTitle:
Claims Examiner - Workers CompensationLocation: ONSITE - Syracuse NYDuration:
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.
To analyze complex or technically difficult workers' compensation claims to determine benefits due. This role involves managing high-exposure claims that may involve litigation and rehabilitation, ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Additionally, the position includes identifying subrogation opportunities and negotiating settlements.
What You'll Do
Claims Analysis and ProcessingAnalyze 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 SettlementNegotiate 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 CompliancePrepare necessary state filings within statutory limits.Manage the litigation process; ensure timely and cost-effective claims resolution.Vendor CoordinationCoordinate 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 ManagementManage 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 DocumentationCommunicate 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.You will need to have:
Education & LicensingBachelor's degree from an accredited college or university preferred.Valid NY Adjuster's License required.ExperienceThree (3) years of claims management experience or an equivalent combination of education and experience required.Skills & KnowledgeSubject 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.