Senior Claims Adjuster I | New York


Job title: “Senior Claims Adjuster I | New York”


Anticipated wage: “$55000 – 85000 per yr”

Location: “Albany, NY”

Job description: Location: Albany, NY
Job_Code: 6068
# of Openings: 1

Job Transient

Distant Alternative!

Claims Adjuster – New York (Employee’s Compensation) | 100% Distant Alternative – East Coast Hours (M-F 8am-5pm ET)

***MUST be licensed in NY


Carry out duties to independently handle a caseload of advanced staff’ compensation claims, decide compensability, set reserves, and course of funds, throughout the limits of normal or accepted observe. Analyzes and interprets statutes and rules making use of to case information to render acceptable authorized and moral choices. Analyzes authorized points and directs authorized technique. Makes use of impartial judgment in decision-making, managing claims in a immediate and thorough method from inception by means of closure. Aggressively negotiates settlement of claims. Helps supervisor or supervisor as wanted. Work shall be carried out underneath direct supervision inside a computer-based atmosphere. Regularly will increase technical information. #LI-Distant #HP22

Important Capabilities:

  • 5+ years of New York Work Comp Claims Adjusting expertise
  • Accountable for advanced, litigated and/or excessive publicity circumstances. Obtain and evaluation info associated to new claims. Talk with injured staff, employers, and medical suppliers. Direct or conduct immediate and thorough investigation of case information and circumstances. Analyzes case information, applies acceptable statutes and rules in decide compensability. Understands and adheres to Claims Greatest Practices.
  • Utilizing impartial judgment and evaluation of value components could assign case to contactor for investigation of circumstances when compensability is questionable.
  • Precisely calculates and pays acceptable advantages in a well timed method, proactively manages declare prices and bills.
  • Arrange file diaries, handle medical therapy, set up reserves as much as authority stage, submit reserve suggestions of upper stage for authorization, and file required State kinds. Doc follow-up care, actions taken to settle declare and different declare associated exercise. Has authority to settle claims.
  • Independently analyzes case information to determine well timed and correct case reserves. Requires information of medical disabilities and associated prices, in addition to judgment of extent of incapacity. Applies information of medical procedures, disabilities, and sure period to find out correct estimate of declare value.
  • Repeatedly analyzes case information to determine potential fraud or abuse all through course of declare.
  • Observe up with contacts to medical supplier and insured employer relating to injured staff’ progress. Ensures high quality case and medical administration by making use of acceptable medical ideas, and by decoding and making use of acceptable statutes and rules. Requires a excessive diploma of impartial judgment to use information of case and render correct choices. Help the method by scheduling medical or testing appointments and offering authorizations. Reveal sound medical administration expertise and aggressive claims dealing with, proactively pursuing return to work.
  • Utilizing sturdy claims administration expertise independently develops, displays and adheres to a written plan of motion to facilitate ongoing declare administration, fast decision and absolute best final result.
  • Proactively manages declare litigation course of. Handles authorized points that may be adjudicated with out using a protection legal professional. Directs authorized technique and participates in preparation of case for subsequent stage(s) of litigation. Testifies at these ranges as required.
  • Composes skilled letters to insured’s, physicians and staff, as essential.
  • Evaluate and reply to incoming mail, emails, phone calls and fax transmissions from suppliers and injured employee, associated to caseload. Take actions required to reply inside rules and coverage.
  • Evaluate and approve or deny medical payments.
  • Audits doctor studies of everlasting partial incapacity evaluations to make sure accuracy in accordance with the precise jurisdictional guides. Ensures immediate and acceptable processing of permanents partial incapacity advantages.
  • Evaluates, prepares, and presents circumstances of potential everlasting complete incapacity to the suitable jurisdiction division.
  • Evaluates and identifies third get together legal responsibility.
  • Participates with Underwriting Division as wanted in agent or insured’s claims staffing.
  • Assumes the duties of Co-Adjusters of their absence.
  • Gives testimony at hearings as wanted.
  • Conduct enterprise always with the very best requirements of non-public, skilled and moral conduct.
  • Ensures well timed compliance with all coverage and procedures in addition to jurisdictional statutes.
  • Ensures well timed and impartial compliance with administration points; prioritizes and ensures well timed completion of actions and assignments.
  • Established and maintains ongoing skilled communications with all acceptable events, inner and exterior, guaranteeing satisfaction with firm companies.
  • Mentors junior Claims Adjusters.
  • Acts as a useful resource/advisor for the division on the correct interpretation and utility of jurisdictional and regulatory issues, insurance policies, and procedures associated to staff’ compensation claims administration and supplies formal coaching as wanted.
  • Maintains skilled and technical information by attending employer sponsored coaching courses.
  • Visits employers relative to claims administration, as required.
  • All different duties as assigned or as state of affairs dictates.
  • Could fill in for absent supervisor.

Required Minimal {Qualifications} / Data, Abilities & Talents:

  • 5+ years of NY WC claims adjusting expertise
  • Superior written and oral communication, listening, interpersonal, customer support and phone expertise
  • Proficient within the use and information of MS Workplace software program, with the flexibility to sort at a minimal of 35 wpm.
  • Demonstrated information of Employees’ Compensation legal guidelines and talent to stick to statutes, rules and firm insurance policies and practices, in addition to associated declare administration procedures/protocols. Complete information of AMA Guides to the Analysis of Everlasting Impairment and medical terminology. Energetic New York license required.
  • Self motivated with the flexibility to work independently with minimal path. The flexibility to multi-task, expertise to find out the relative significance of every, adhere to deadlines, and full assignments accordingly.
  • Wonderful analytical, downside fixing and decision-making expertise and talent to deal professionally with individuals in annoying conditions.
  • Capability to take care of confidentiality.
  • If State Certification is required, should meet certification inside state mandated time-frame.
  • Should have Excessive College Diploma or GED equal.
  • Minimal of 8+ years expertise working in a claims atmosphere on the Adjuster stage or greater managing publicity misplaced time claims of a posh nature.
  • Capability to take part in job associated inner and exterior coaching and move any assessments throughout the set tips.

Most popular {Qualifications} / Data, Abilities & Talents:

  • Bachelor’s diploma
  • AIC, ARM, or CPCU certification, working information of a claims administration system.
  • Working information of an imaged claims atmosphere.
  • Bilingual in English and Spanish.
  • Present Skilled Claims Adjuster Designation.

Pay Vary $55,000 – $85,000 (mentioned on first interview) + complete advantages package deal. Please observe the hyperlink to our advantages web page for particulars!

Work Atmosphere:

  • Distant: This function is distant, and solely open to candidates at present situated in america and in a position to work with out sponsorship.
  • It requires an appropriate area that gives a personal and quiet office.
  • Anticipated Work Hours: Schedules are set to accommodate the necessities of the place and the wants of the group and could also be adjusted as wanted.
  • Journey: Could also be required to journey to off-site location(s) to attend conferences, as essential

EMPLOYERS is a dynamic, fast-growing supplier of staff’ compensation insurance coverage and companies, we’re looking for a goal-oriented particular person keen to place their concepts to work!

We provide a constructive, difficult work atmosphere, mixed with a possibility to construct your profession as you assist us develop our enterprise, in progressive and imaginative methods which might be uniquely EMPLOYERS®!

Headquartered in Reno, Nevada, EMPLOYERS/ attributes its long-standing success to its most useful useful resource, our staff throughout america. EMPLOYERS/ is understood for the standard service and experience we offer to our purchasers, and the exemplary work atmosphere we offer for our staff.

We reside and breathe our core values: Integrity, Buyer Focus, Collaboration, Initiative, Accountability, Innovation, and Private Success. These are the pillars that assist how we do enterprise with our purchasers in addition to how we deal with one another!

At EMPLOYERS, you’ll uncover an lively atmosphere that conjures up high achievement. As “America’s small enterprise insurance coverage specialist”, we’ve got the assets, a stable fame, and an increasing nationwide identification to complement your work/life and improve your profession.


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