C. WinChell Agency
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Job Title : Senior Claim Specialist - Workers Compensation
   Jobcode : 20898
   Description : Examine claims data and conduct investigations into routine and moderately complex claims to determine coverage, compensability, subrogation and benefits under moderate supervisory direction. Adjust and manage claims within the limit of assigned authority. Receive lost time and complex medical only assignments for the state of NY. Verify and determine applicability of coverage. Initiate 24 hour contact with employer, employee and 48 hour contact with attending physician. Handle catastrophic claims with supervisory oversight. Conduct telephone investigations. Evaluate and adjust claims within the limits of authority. Consult with Claim Manager on claims when needed. Make assignments to nurse case management when indicated, monitoring their billing and performance. Set reserves for anticipated exposure up to authority limits. Complete mandatory RAW forms. Establish reserves requiring complex analysis with lifetime pharmacy and cost inflation. Coordinate return to work (RTW) and set target dates. Maintain diaries on maximum 3 month intervals. Document files in claims system. Review medical bills for causal relationship, medical bill charges for appropriateness and approve payments. Adhere to special account handling (SHI) instructions. Attend account meetings by telephone and in-person. Manage litigation on files.
   City : Parsippany Area
   State : NJ
   Requirement : Must be well versed in New York Workers Compensation statute. Bachelor’s Degree or equivalent experience. Minimum 8+ years experience handling New York workers compensation claims. Strong organizational and time management skills. Foreign language communications a plus. Excellent verbal and written communication skills are essential. Strong aptitude and knowledge of Microsoft Office and the ability to quickly learn new programs. Abide by departmental policies and procedures, including authority levels, to comply with risk management controls.
   Base Pay Low : $75,000
   Base Pay High : $85,000
           

 

Job Title : Workers Compensation Claims Examiner
   Jobcode : 20986
   Description : Interested in a growing company that specializes in Workers Compensation Risk Management for their diverse clients? Immediate position available for experienced New York Lost Time and Litigation Adjuster.
   City : Long Island
   State : NY
   Requirement : New York Workers Compensation experience. TPA or Broker experience preferred. New York Adjuster’s License preferred, but will assist in having it obtained. College degree desired as well. Experience with catastrophic injury claims needed.
   Base Pay Low : $70,000
   Base Pay High : $80,000
           

 

Job Title : Workers Compensation Claims Representative
   Jobcode : 21069
   Description : Receives new medical only workers’ compensation claim assignments of minor to moderate complexity level. Analyzes the nature of the claim to determine required investigation and handling. Determines and identifies compensability issues or questions of coverage in accordance with MSMM Claims Handling Guidelines.Performs timely and thorough investigations in compliance with all jurisdictional requirements and/or entitlements.Conducts an informed case analysis to initiate reserve changes within assigned authority and makes recommendations to supervisor or manager where assigned authority is exceeded.Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practice requirements and company policy and procedures.Maintains current case diary and ensures retention of appropriate hard copy file documentation. Provides accurate claims system documentation as required by company claim manuals and procedures. Responsible for completion and/or submission of claim forms and reports as required by outside agencies.May handle subrogation of claims within delegated limits of authority, including identification of responsible parties, preparation of claim notice, correspondence with carriers, and negotiation of settlement in accordance with MSMM Recovery Procedures.Services the claim needs of our customers including insureds, claimants, brokers, etc., in accordance with company policy and procedures, and attends client visitations with underwriters and other parties to conduct presentations and reviews.Maintains ongoing communication with all customers throughout the claims process in an effort to provide timely and appropriate claim status as appropriate and/or required by statutory regulations.
   City : Cincinnati
   State : OH
   Requirement : Bachelor’s degree (B. A.) from four-year college or university is preferred. 2+ years of industry experience.
   Base Pay Low : $60,000
   Base Pay High : $75,000
           

 

Job Title : Workers Compensation Claims - 100% REMOTE
   Jobcode : 21081
   Description : Our client is looking for a Remote Super Star to add to staff! If you are a detailed oriented individual - this is the job for you! Active workers compensation claims desk requiring a well-rounded remote examiner to handle all aspects of NJ workers compensations claims through litigation.
   City : Parsippany Area
   State : NJ
   Requirement : 5-10 years experience handling NJ and PA hospital/healthcare workers compensation claims. Must have experience with lost time and litigation. Must be detail oriented with special attention to “Best Practices”. Multi-state adjusters license desired.
   Base Pay Low : $70,000
   Base Pay High : $90,000