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WC CLAIMS ADJUSTER

L5

hereford insurance companyLong Island City, NY3 days ago

Occupations

Claims Adjusters, Examiners, and InvestigatorsArbitrators, Mediators, and ConciliatorsAdministrative Law Judges, Adjudicators, and Hearing Officers

Industries

Claims AdjustingAll Other Insurance Related ActivitiesPharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds
Job TitleReview and process mail (Board decisions, attorney correspondence, and authorization request). Review and issue timely payments of awards from the Workers' Compensation Board.
Essential Duties & Responsibilities:
  • Maintain an open file case load (approximately 150); and a 1:1 closing ratio.
  • Handle a case load of catastrophic aims, PPD and high cost claims.
  • Provide reserve and settlement authority ($30,000), Refer higher limit Files to the manager for authority.
  • Resolve and settle cases with Workers' Compensation attorneys and HIC hearing reps; request appeals where applicable.
  • Assign cases for ME, Investigations and Case Management.
  • Negotiate and settle outstanding medical bills.
  • Settle cases through Section 32 and SLU process.
  • Complete 3 point contact (claimant, insured and provider) within 48 hours.
  • Timely filing of WCB forms to avoid penalties, Timely processing of Workers' Compensation Board awards.
  • Review medical bills for payment and causal relationship.
  • Issue timely payments (bi-weekly) including CCP Indemnity and awards, Maintain a daily diary of pending.
  • Follow-up with subrogation (loss transfer and 3rd party claims).Other DutiesThis job description in no way states or implies that these are the only duties to be performed. You will be expected to follow any other job-related instructions and to perform other job-related duties as requested by your supervisor.
Qualifications: At least 5 years proven, current experience as a NY workers' compensation claims examiner/adjuster: detailed working knowledge of the additions to the medical treatment guidelines effective 2014.Supervisory Responsibilities Physical Demands While performing the duties of this job, the employee is frequently required to sit for long periods while using a computer with keyboard, screen and mouse; talk, listen on the telephone and in person; read and write; apply logic and focus attention in the presence of distraction, Occasional requirements are to stand or walk for brief periods. Training On-the-job training including but not limited to Imageright and AS400.Decision Making Financial Responsibilities Reserve authority up to $30k.
Communication: Effective verbal, written and interpersonal communication skills.
Results of Action: Successful actions will result in the complete, timely and accurate payments of awards.
Equipment Used: Equipment used is primarily a personal computer, peripherals and related software.
Work Environment: The work environment consists of indoor highly regulated, time sensitive, teamwork environment in a standard office setting utilizing a cubicle as a work station.
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Level

SeniorL5

Location

Long Island City, NY

Occupation

Claims Adjusters, Examiners, and Investigators

Industry

Claims Adjusting

Posted

3 days ago

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