Workers Compensation Claims Examiner I NY license required I Remote

Lensa; New York (NY); Remote; USD 56,000 - 80,000; Full time

Job summary

A leading company is seeking a Workers Compensation Claims Examiner to analyze complex claims and manage litigation processes. This remote position requires a New York license and involves negotiating settlements and ensuring timely adjudication. Candidates should have at least five years of claims management experience and a Bachelor's degree is preferred.

Qualifications

• Minimum five years claims management experience.
• Expertise in insurance principles, laws, and claims practices.
• Professional certification is a plus.

Responsibilities

• Analyze and process complex claims, manage claims to resolution.
• Negotiate claim settlements within authority limits.
• Manage litigation processes and coordinate investigations.

Skills

Communication

Negotiation

Organizational

Analytical

Education

Bachelor's degree

Job description

Workers Compensation Claims Examiner I NY license required I Remote

This role involves analyzing complex workers' compensation claims, managing litigation and rehabilitation, and negotiating settlements. The position requires a NY license and is remote.

PRIMARY PURPOSE: To evaluate complex workers' compensation claims, ensure timely adjudication, and identify subrogation opportunities.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

1. Analyze and process complex claims, investigate information, and manage claims to resolution.
2. Negotiate claim settlements within authority limits.
3. Assign and manage reserves; calculate and pay benefits promptly.
4. Prepare state filings within statutory limits.
5. Manage litigation processes and coordinate investigations or legal actions.
6. Use cost containment techniques and manage recoveries such as subrogation.
7. Report claims to carriers, communicate with claimants and clients, and maintain proper documentation.

ADDITIONAL FUNCTIONS:

• Perform other duties as assigned, support quality programs, and travel as needed.

QUALIFICATIONS:

• Preferred Bachelor's degree; professional certification is a plus.
• Minimum five years claims management experience.
• Expertise in insurance principles, laws, and claims practices.
• Strong communication, negotiation, organizational, and analytical skills.

WORK ENVIRONMENT: Includes considerations for reasonable accommodations, with mental, physical, and visual demands outlined.

Salary range: $56,909 - $79,672, with comprehensive benefits.