Workers' Comp Claims Specialist & Negotiator

CitiMed; New York (NY); On-site; USD 34,000 - 55,000; Full time

Job summary

CitiMed is seeking a Workers’ Compensation Claims Associate who will independently evaluate and resolve assigned claims in line with statutory guidelines. The role involves coordinating medical care, negotiating settlements, and advocating for clients to ensure cost-effective outcomes.

Ideal candidates have 2–5 years of WC billing experience, strong knowledge of NY regulations, and familiarity with HIPAA compliance.

Qualifications

• 2–5 years of workers’ compensation billing experience.
• Knowledge of NY no-fault and workers’ compensation regulations.
• Familiarity with HIPAA rules and compliance.

Responsibilities

• Independently evaluate, investigate, and resolve assigned workers’ compensation claims.
• Coordinate medical care and negotiate to achieve cost-effective outcomes.
• Serve as an advocate on client claim issues and provide technical expertise.
• Promptly investigate assigned claims from basic to complex medical/indemnity files.
• Make timely compensability determinations per jurisdictional requirements.
• Identify potential fraud indicators and notify management for further investigation.
• Notify excess carriers per guidelines and request timely reimbursement.
• Negotiate settlements within authority and process/track award payments.
• Maintain forms, rules, and regulations relevant to NY WC processes.
• Maintain follow-up systems for all cases to ensure timely reimbursement.
• Ensure a minimum productivity of cases per day and proper documentation.

Skills

WC billing

HIPAA compliance

NY regulations knowledge

Job description

CitiMed is seeking a Workers’ Compensation Claims Associate who will independently evaluate and resolve assigned claims in line with statutory guidelines. The role involves coordinating medical care, negotiating settlements, and advocating for clients to ensure cost-effective outcomes.

Ideal candidates have 2–5 years of WC billing experience, strong knowledge of NY regulations, and familiarity with HIPAA compliance.