Claim Specialist III

2 days ago


New York, New York, United States City of New York Full time
Job Title: Claim Specialist III

This is a challenging and rewarding role within the City of New York's Comptroller's Office, where you will play a critical part in promoting the financial health and integrity of the city.

Key Responsibilities:
  • Manage individual No-fault files and review investigation reports, medical reports, bills, and ledgers to determine eligibility for No-fault benefits.
  • Authorize and process payments of medical bills using fee schedules, lost wages, and additional reimbursements on 1st-Party No-fault claims.
  • Handle the division's participation in AAA American Arbitration Association dispute resolution on 1st-Party No-Fault claims and address 3rd-Party No-Fault Arbitrations.
  • Set up No-fault claim files, including issuing and processing NF2 applications, confirming the City's involvement on claim submissions, and issuing verification letters to claimants and medical providers.
  • Process Lost Wages and additional expenses on 1st-Party No-Fault claims.
  • Respond to New York State Department of Financial Services correspondence.
  • Negotiate and settle claims within delegated monetary authority levels.
  • Review medical providers and law firms to ensure they are in the Financial Management System, including confirming accurate and most recent W-9 forms.
  • Maintain accurate and complete claim files, prepare claim abstracts, document events or conversations in claim notes, and upload documents upon receipt.
  • Use available databases, media outlets, and other sources to gather information relevant to claim investigations.
  • Investigate, identify, and report fraudulent claims, utilize statistical data to identify claims that pose potential risks, and provide risk management recommendations to the Division Chief.
  • Maintain control over claim backlogs, timely follow-up on requests made to agencies, and close out claims beyond the statutory time frame to bring a lawsuit.
  • Communicate effectively and professionally with other Comptroller staff, City agency employees, pro se claimants, and attorneys when investigating claims or negotiating settlements.
Requirements:
  • Current City of New York employees serving in a permanent (not provisional) Civil Service title of Claim Specialist.
  • A baccalaureate degree from an accredited college or university, or an associate degree or 60 semester credits from an accredited college or university and two years of full-time satisfactory experience investigating and/or settling claims for personal injury or property damage or loss.
Preferred Skills:
  • Significant knowledge of 1st-Party No-Fault claims process, including investigation, adjustment, and disposition of claims, and the Comptroller's Office's role in adjusting and settling claims.
  • Strong analytical and negotiation skills.
  • The ability to manage and inspire a diverse group of staff.
  • Exceptional organizational, writing, and verbal communication skills.
  • The ability to perform effectively in a fast-paced environment while managing multiple priorities.

This is an exciting opportunity to join the City of New York's team and contribute to the financial health and integrity of the city. If you are a motivated and detail-oriented individual with a passion for claims management, we encourage you to apply for this role.


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