Claim Specialist I – IV, New York WC Claims

This is a fully remote position, open to applicants in New York.

📋 Description

• Engages with insured individuals, injured workers, agents, brokers, witnesses, attorneys, loss prevention specialists, and underwriters to gather and communicate essential information for assessing coverage/compensability, loss facts, and liability/exposure levels.

• Oversees the timely provision of appropriate and precise indemnity and medical benefits.

• Assesses claim exposure, negotiates, and resolves claims. Collaborates closely with defense counsel on litigated cases and attends mediation, arbitration, and hearings as needed. Formulates a litigation strategy with defense counsel and monitors compliance with the plan to manage legal costs and ensure effective resolution.

• Works in partnership with insureds and employees, conducting visits and presentations as necessary to promote a collaborative approach to claims management.

• Maintains high-quality claim files following best practices and company policies.

• Implements Managed Care strategies, coordinates rehabilitation or medical management, processes invoices, reviews all correspondence through Image Right, and tracks progress as required.

• Engages with State and Federal Boards and Commissions while establishing and maintaining appropriate reserves as necessary.

• Acts as a mentor and assists in training and preparing less experienced representatives in the Claims Department.

• Stays current on State laws and Company procedures related to various claims; educates injured workers and/or insureds accordingly.

• Prepares and presents files for Agent/Broker Reviews and Insured File Reviews.

• Possesses a solid understanding of medical terminology and standard medical procedures related to worker’s compensation, U.S. Longshoreman’s, and Jones Act claims.

• Takes part in both in-house and external training programs to remain informed on pertinent issues/topics.

• Maintains proficiency in all computer systems currently utilized.

• Travels throughout the States as required to manage assigned claims inventory.

⛳️ Requirements

• One to four years of experience in handling lost time claims related to workers’ compensation is preferred.

• A Bachelor’s degree is preferred.

• Proficiency in computer skills, including Word, Excel, and Image Right, is preferred.

• A valid driver’s license is required.

• Strong attention to detail along with excellent verbal and written communication skills.

• Must be adaptable, flexible, and self-directed, with the ability to effectively manage time, multiple priorities, and other resources.

• Ability to work collaboratively with other members of the organization is essential.

🏝️ Benefits

• Options for Health Insurance, Dental Insurance, and Vision Insurance.

• Employee Life Insurance/AD&D and options for Dependent Life Insurance.

• Short-term and Long-term Disability coverage.

• Health Savings Account with potential employer match.

• Flexible Medical and Dependent Care Accounts.

• Accident Insurance and Critical Illness Insurance.

• Employee Assistance Program.

• Legal/Identity Theft Insurance options.

• Long Term Care Insurance.

• Pet Insurance.

• 401(k) Retirement Plan with up to 6% match, plus an annual bonus based on individual and company performance.

• Five weeks of Paid Time Off (PTO).

• Eleven paid holidays.