Workers Compensation Claims Examiner

Role Overview

• Independently handle a capped caseload of workers' compensation claims, from inception to resolution, ensuring adherence to company procedures, industry best practices, and regulatory requirements.
• Ensure compliance with New York workers' compensation laws, including timely filing of reports, adherence to benefit payment timelines, and compliance with statutory requirements.
• Negotiate settlements of claims within designated authority to reach claim resolution.
• Provide clear and effective communication with the claimant and client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
• Maintain accurate and comprehensive records in the claims management system, documenting all actions, decisions, and correspondence related to each claim.

Requirements

• Minimum of (2) years of workers' compensation claims handling experience.
• Experience specifically with New York jurisdictional regulations, including knowledge of New York State Workers' Compensation Board rules and procedures.
• Experience with Public Entity claims management.
• Strong understanding of workers' compensation claims processes, policies, and legal requirements in New York.
• Excellent written and verbal communication skills.
• Strong analytical skills with attention to detail and accuracy.
• Ability to manage multiple claims simultaneously and prioritize workload effectively.
• Proficiency with claims management software and Microsoft Office Suite (Excel, Word, Outlook).
• Ability to negotiate settlements and resolve claims disputes effectively.

Benefits

• Flexible work schedule.
• Capped Case Load.
• In-depth training.
• Sedgwick funded licensing.
• Referral incentive program.
• Opportunity to work in an agile or remote environment.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.