Claims Adjuster II

Job Description:

• Promptly investigate all assigned claims with minimal supervision, including those of a more complex Construction nature
• Determine coverage, compensability, potential for subrogation recovery, and other offsets (when applicable)
• Alert Supervisor and carriers Special Investigations Unit to potentially suspect claims
• Ensure timely denial or payment of benefits in accordance with jurisdictional requirements
• Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure
• Negotiate claims settlements with carriers approval
• Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition
• Work collaboratively with medical professionals to develop and execute return to work strategies
• Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome
• Maintain a working knowledge of New York State requirements and applicable case law for NY
• Demonstrate technical proficiency through timely, consistent execution of best claim practices
• Communicate effectively, verbally and in writing, with internal and external parties on a wide variety of claims and account issues
• Provide a high degree of customer service to clients, including but not limited to day to day interactions, claims reviews and renewal meetings
• Authorize medical treatment based on protocols established by NYS WC law
• Assist Underwriting on new and renewal business

Requirements:

• Claims Adjusters License required
• Bachelor's degree, or four or more years of equivalent work experience
• At least 3 or more years’ experience handling New York State lost time workers compensation construction claims for Associate in Claims (AIC) Designation or similar professional designation desired
• Familiarity with medical terminology
• Strong organizational skills and ability to manage multiple tasks simultaneously
• Demonstrated ability to work independently and with a team
• Ability to analyze data and make sound decisions
• Strong Knowledge of OSHA construction standards
• Knowledge of NYS labor Law §240
• Computer literacy, including working knowledge of MS Office products including Word, Excel and PowerPoint
• Knowledge of Claim Center a plus
• Ability to travel for business purposes, less than 15%

Benefits:

• Health insurance
• 401(k) matching

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