Senior Workers' Comp Claims Adjuster – Catastrophic Claims

Hereford Insurance Company; New York (NY); On-site; USD 70,000 - 78,000; Full time

Job summary

Hereford Insurance Company seeks a NY workers' compensation claims examiner/adjuster to review mail, authorize and timely pay WCB awards. Maintain ~150 open files with a 1:1 closing ratio and manage catastrophic, high-cost claims with $30,000 reserve authority, escalating higher limits to management when needed.

Responsibilities include settling cases with WC attorneys, assigning cases for ME and investigations, and ensuring prompt 3-point contact within 48 hours.

Qualifications

• 5+ years proven, current experience as a NY workers' compensation claims examiner/adjuster.
• Detailed working knowledge of the medical treatment guidelines effective 2014.
• On-time processing of Workers' Compensation Board payments and settlements.

Responsibilities

• Review and process mail including board decisions, attorney correspondence, and authorization requests.
• Review and issue timely payments of WCB awards and CCP indemnity.
• Maintain an open file caseload (approx. 150) with a 1:1 closing ratio.
• Handle catastrophic, high-cost claims and reference reserves up to $30,000; escalate higher limits to manager.
• Resolve cases with WC attorneys and hearing reps; refer appeals where applicable.
• Assign cases for ME, investigations, and case management; negotiate and settle medical bills.
• Settle cases through Section 32 and SLU processes; complete 3-point contact within 48 hours.

Skills

Attention to detail

Case management

Negotiation

Timely payments

Tools

AS400

Imageright

Job description

Hereford Insurance Company seeks a NY workers' compensation claims examiner/adjuster to review mail, authorize and timely pay WCB awards. Maintain ~150 open files with a 1:1 closing ratio and manage catastrophic, high-cost claims with $30,000 reserve authority, escalating higher limits to management when needed.

Responsibilities include settling cases with WC attorneys, assigning cases for ME and investigations, and ensuring prompt 3-point contact within 48 hours.