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Senior Workers' Compensation Claims Specialist
2 months ago
Location: Remote option available
Status: Exempt
POSITION OVERVIEW: Responsible for overseeing all facets of indemnity claims management from initiation to resolution in accordance with established protocols.
KEY RESPONSIBILITIES:
- Handles a portfolio of 100 to 125 workers' compensation cases, including intricate claims.
- Conducts prompt investigations.
- Evaluates claim validity and administers benefits in compliance with state regulations and company policies.
- Oversees medical treatment and billing processes.
- Refers cases to legal counsel when appropriate.
- Engages with claimants, healthcare providers, and service vendors.
- Establishes reserves in line with company standards.
- Finalizes all claims with the necessary authority.
- Maintains a diary system and documents case developments.
- Communicates effectively with clients and addresses safety issues.
- Follows company policies and procedures diligently.
- Independently performs file assessments.
- Additional responsibilities as assigned.
REQUIRED QUALIFICATIONS:
Education/Experience: Bachelor's degree preferred; three or more years of relevant experience; or a suitable combination of education and experience.
Knowledge, Skills, and Abilities:
- In-depth understanding of statutory regulations and medical terminology.
- Strong analytical capabilities.
- Exceptional communication skills.
- Ability to engage with individuals at various organizational levels.
- Effective management of complex claims.
- Proficiency in Word and Excel is preferred.
- Valid New York state adjuster license is mandatory.
