Senior Catastrophic Workers' Comp Claims Specialist

ADP, Inc.; New York (NY); On-site; USD 70,000 - 78,000; Full time

Job summary

ADP, Inc. in New York is seeking an experienced NY workers' compensation claims examiner/adjuster to review mail, issue timely awards and manage a high-volume caseload.

You will handle catastrophic claims, set reserves up to $30,000, and coordinate with attorneys and hearing reps to ensure prompt resolutions. Strong organizational skills are required to maintain a daily diary, file WCB forms on time, and process medical bills for causal relationships.

Qualifications

• At least 5 years proven, current experience as a NY workers' compensation claims examiner/adjuster.

Responsibilities

• Review and process mail (Board decisions, attorney correspondence, and authorization request).
• Review and issue timely payments of awards from the Workers' Compensation Board.
• Maintain an open file case load (approximately 150) and a 1:1 closing ratio.
• Handle a case load of catastrophic aims, PPD and high cost claims.
• Provide reserve and settlement authority ($30,000); refer higher limit files to the manager for authority.
• Resolve and settle cases with Workers' Compensation attorneys and HIC hearing reps; request appeals where applicable.
• Assign cases for ME, Investigations and Case Management.
• Negotiate and settle outstanding medical bills.
• Settle cases through Section 32 and SLU process.
• Complete 3 point contact (claimant, insured and provider) within 48 hours.
• Timely filing of WCB forms to avoid penalties, timely processing of Workers' Compensation Board awards.
• Review medical bills for payment and causal relationship.
• Issue timely payments (bi-weekly) including CCP Indemnity and awards, maintain a daily diary of pending.
• Follow-up with subrogation (loss transfer and 3rd party claims).
• This job description in no way states or implies that these are the only duties to be performed.

Tools

Imageright

AS400

Job description

ADP, Inc. in New York is seeking an experienced NY workers' compensation claims examiner/adjuster to review mail, issue timely awards and manage a high-volume caseload.

You will handle catastrophic claims, set reserves up to $30,000, and coordinate with attorneys and hearing reps to ensure prompt resolutions. Strong organizational skills are required to maintain a daily diary, file WCB forms on time, and process medical bills for causal relationships.