Now Hiring! Claims Examiner
Location: Spring Valley, NY 10977 [on-site 3+ days per week]
What's in it for You:
- Medical, Dental, Vision Benefits
- 401K eligible upon 1st day of employment
- FSA & DCA Accounts
- Career advancement opportunities in an expanding company
Job Summary: Claimsake is efficient workers’ comp claims management and support from report to resolution presented by Highview National Insurance, an insurance carrier that provides workers’ compensation coverage. We pride ourselves on having an exceptional team environment, with multiple avenues for growth opportunities. We are currently hiring for a new
Claims Examiner to be responsible for the investigation and management of workers' compensation claims in
New York state, including medical management and litigation management to drive claims to closure while working to actively mitigate exposure for the Company. As
Claims Examiner, you are expected to work full-time [40 hours per week] and work on-site in our office in Spring Valley, NY at least three days per week in a hybrid capacity.
What You’ll Do:
- Responsible for completing and documenting initial loss investigations to determine compensability.
- Establish initial and subsequent reserves to ensure reserves are adequate for anticipated exposure.
- Review medical bills for causal relationship to reported claim.
- Liaison with insureds, nurse case managers, and counsel to oversee management of claims and bring them to closure and facilitate full or transitional duty return to work.
- Develop and maintain action plans to ensure reserve adequacy and bring claims to a timely resolution.
- Negotiate settlement of claims within designated authority.
- Prepare and present claim review summaries for insureds, brokers, internal contacts as requested.
- Participate in roundtable discussions with insured and counsel on strategies for successful claim closure/resolutions.
- Provide guidance and assistance to insureds and brokers on timely reporting of claims.
- Manage insured onboarding including training on claims reporting and the use of the insured portal.
- Other duties as assigned.
What You’ll Need:
- Minimum experience of 5 years adjusting worker's compensation claims in multiple jurisdictions:
- New York experience required; New Jersey and Pennsylvania preferred.
- Healthcare and/or Construction industry experience preferred.
- Bachelor's degree preferred but not required.
- Professional designation such as CPCU, ARM, CRM, or similar preferred.
This list of functions, duties, responsibilities, and skills is not intended to be all-inclusive, and the employer reserves the right to assign additional duties and responsibilities as necessary.
Claimsake is an Equal Opportunity Employer. Claimsake does not discriminate based on race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status, or any other basis covered by appropriate law. All employment is decided based on qualifications, merit, and business needs.
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