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Senior Claims Specialist

2 months ago

Syracuse, New York, United States The Amynta Group Full time

We are excited about your interest in becoming a part of our team at The Amynta Group.

This position is within the Oryx Insurance Brokerage division, a recognized leader in providing professional underwriting services and support. Collaborating with top-rated insurance carrier partners, Oryx specializes in developing, marketing, and underwriting insurance products tailored for the construction sector. As a Senior Claims Specialist on the Oryx claims team, you will leverage your expertise in Workers Compensation to autonomously investigate, assess, and resolve complex claims related to construction, ensuring optimal outcomes. In this role, you will manage and resolve Workers Compensation claims promptly, adhering to legal statutes, policy provisions, and carrier guidelines.
Key Responsibilities:

  • Conduct thorough investigations of all assigned claims with minimal oversight, particularly those of a complex construction nature.
  • Evaluate coverage, compensability, potential for subrogation recovery, and other offsets as applicable.
  • Notify supervisors and the Special Investigations Unit of any potentially suspicious claims.
  • Ensure timely denial or payment of benefits in compliance with jurisdictional requirements.
  • Establish and maintain appropriate reserves with documented justification, adjusting reserves throughout the claim's lifecycle to reflect changes in exposure.
  • Negotiate settlements with carrier approval.
  • Develop and implement effective action plans for case resolution, including medical and disability management, litigation management, negotiation, and disposition.
  • Collaborate with medical professionals to create and execute return-to-work strategies.
  • Select and oversee service vendors to balance allocated expenses with loss outcomes.
  • Maintain a comprehensive understanding of New York State requirements and relevant case law.
  • Exhibit technical proficiency through the timely and consistent application of best claims practices.
  • Communicate effectively, both verbally and in writing, with internal and external stakeholders regarding a variety of claims and account issues.
  • Deliver exceptional customer service to clients, including day-to-day interactions, claims reviews, and renewal meetings.
  • Authorize medical treatment in accordance with established protocols.
  • Assist underwriting teams with new and renewal business.
Qualifications:
  • Claims Adjusters License is required.
  • Bachelor's degree or four or more years of equivalent professional experience.
  • A minimum of three years' experience managing New York State lost time workers compensation claims in the construction sector.
  • Associate in Claims (AIC) designation or similar professional credential is preferred.
  • Familiarity with medical terminology is essential.
  • Strong organizational skills with the ability to manage multiple tasks concurrently.
  • Proven ability to work independently as well as collaboratively within a team.
  • Capability to analyze data and make informed decisions.
  • Excellent verbal and written communication skills.
  • In-depth knowledge of OSHA construction standards.
  • Understanding of NYS Labor Law §240.
  • Proficient in computer applications, including MS Office Suite (Word, Excel, PowerPoint); knowledge of Claim Center is a plus.
  • Willingness to travel for business purposes, less than 15% of the time.
The Amynta Group is committed to a policy of Equal Employment Opportunity and will not discriminate against any applicant or employee based on any protected characteristic. The information collected is solely for assessing suitability for employment, verifying identity, and maintaining employment statistics.

Applicants with disabilities may be entitled to reasonable accommodations throughout the recruitment process in accordance with applicable legislation. A reasonable accommodation may include adjustments to processes, procedures, methods of conveying information, and/or the physical environment to ensure equal employment opportunities for all candidates. The Company will provide accommodations to the extent of undue hardship. Please inform the Company's personnel representative if you require any accommodations during the application process.