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Claims Examiner

2 months ago

Syracuse, New York, United States Experis Full time
{"title": "Claims Examiner - Workers Compensation Role", "description": "

Experis IT ManpowerGroup has partnered with a leading Insurance Co in the Syracuse NY area to fill a Claims Examiner - Workers Compensation position. This is a direct hire opportunity.

  • Candidates must have at least two years of experience handling NY Workers' Compensation lost time claims.
  • Must hold a valid NY Adjusters' License.

This role involves analyzing complex or technically difficult workers' compensation claims to determine benefits due. The position requires 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.

Key Responsibilities:
  • Claims Analysis and Processing
  • Analyze 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 Settlement
  • Negotiate 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 Compliance
  • Prepare necessary state filings within statutory limits.
  • Manage the litigation process; ensure timely and cost-effective claims resolution.
  • Vendor Coordination
  • Coordinate 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 Management
  • Manage 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 Documentation
  • Communicate 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.
Requirements:
  • Education & Licensing
  • Bachelor's degree from an accredited college or university preferred.
  • Valid NY Adjuster's License required.
  • Experience
  • Three (3) years of claims management experience or an equivalent combination of education and experience required.
  • Skills & Knowledge
  • Subject 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.