Workers Compensation Claims Examiner (PPD)

Top Prospect Group; New York (NY); On-site; USD 90,000 - 120,000; Full time

Job summary

Top Prospect Group is seeking a Workers' Compensation Claims Examiner for an onsite role in Queens, NY. The specialist will manage complex NY WC claims with a focus on Permanent Partial Disability (PPD) cases.

Responsibilities include negotiating Section 32 settlements, reserving, medical management, and regulatory compliance. Five+ years of NY WC claims experience required; strong negotiation and communication skills are essential.

Qualifications

• 5+ years of New York Workers' Compensation claims experience.
• Experience with reserve management, disability evaluations, and medical case management.
• Knowledge of NY Workers' Compensation laws, regulations, and claims processes.

Responsibilities

• Manage and review PPD claims and settlements.
• Negotiate Section 32 settlements with claimant attorneys.
• Maintain claim reserves and process payments.
• Coordinate status updates to carriers and leadership.
• Oversee medical treatment plans, IMEs, and disability evaluations.
• File required workers' compensation forms and ensure regulatory compliance.
• Support active claims and long-term disability transitions.
• Calculate compensation benefits and disability ratings.
• Communicate with claimants, attorneys, providers, carriers, and stakeholders.

Skills

Negotiation

Communication

Analytical

Independent work

Job description

Workers' Compensation Claims Examiner (PPD) - Queens, NY (Onsite) / 40-45hr

Our client is seeking an experienced Workers' Compensation Claims Examiner. This position is fully onsite, five days per week, and is responsible for managing complex New York workers' compensation claims with a focus on Permanent Partial Disability (PPD) cases.

Responsibilities

• Manage and review resolved classified PPD claims, including pre-cap and post-cap cases.
• Negotiate Section 32 settlements with claimant attorneys.
• Maintain appropriate claim reserves and process claim payments.
• Coordinate and provide status updates to excess carriers and internal leadership.
• Conduct annual and semi-annual claimant wellness reviews and coordinate follow-up investigations when necessary.
• Oversee medical treatment plans, IMEs, medication approvals, and disability evaluations.
• Serve as backup for active workers' compensation claims, including compensability determinations and claim administration.
• File required workers' compensation forms and ensure regulatory compliance.
• Manage investigations, medical case management, and long-term disability transitions.
• Calculate compensation benefits and evaluate disability ratings and scheduled loss awards.
• Maintain effective communication with claimants, attorneys, medical providers, carriers, and other stakeholders.

Qualifications

• 5+ years of New York Workers' Compensation claims experience.
• Strong experience handling PPD claims and Section 32 settlements.
• Knowledge of New York Workers' Compensation laws, regulations, and claims processes.
• Experience with reserve management, disability evaluations, and medical case management.
• Strong negotiation, communication, and analytical skills.
• Ability to manage complex claims independently in a high-volume environment.