Claims Examiner - REMOTE

Syracuse, NY

Open to Remote

Full Time

Our client is looking for a Claims Examiner on a full-time permanent role in Syracuse, NY. Will be working remotely.

Join over 20,000 employees at this global company specializing in technology-enabled claims and risk management solutions. You will be part of a culture that is constantly recognized for progressive, inclusive employment practices, and be part of a bigger movement to simplify complexities in the areas of workers compensation, liability, property, disability, and absence management. 
You will work alongside some of the smartest minds in the industry who are excited to share their knowledge and to learn from you.

Contract Duration: Full Time

Required Skills & Experience
  • Must have a valid NY Adjuster's License.
  • 2+ years of experience handling NY Worker's Compensation lost time claims.
  • 3 years of claims management experience or equivalent combination of education and experience required.
Desired Skills & Experience
  • Bachelor's degree from an accredited college or university.
What You Will Be Doing
  • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
  • Analyze complex or technically difficult workers' compensation claims to determine benefits due.
  • Work with high exposure claims involving litigation and rehabilitation.
  • Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.
  • Identify subrogation of claims and negotiate settlements.
  • Analyze and process complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim. Manage claims through well-developed action plans to an appropriate and timely resolution.
  • Negotiate settlement of claims within designated authority.
  • Calculate and assign timely and appropriate reserves to claims. Manage reserve adequacy throughout the life of the claim.
  • Calculate and pay benefits due. Approve and make timely claim payments and adjustments. Settle clams within designated authority level.
  • Prepare necessary state fillings within statutory limits.
  • Manage the litigation process. Ensure timely and cost-effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management.
  • Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
  • Manage claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
  • Report claims to the excess carrier. Respond to requests of directions in a professional and timely manner.
  • Communicate claim activity and processing with the claimant and the client. Maintain professional client relationships.
  • Ensure claim files are properly documented and claims coding is correct.
  • Refer cases as appropriate to supervisor and management.
  • Perform other duties as assigned.
  • Support the organization's quality program(s).
  • Travel as required.

Posted by: Lisa Capezio

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