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 Examiner
   Jobcode : 21212
   Description : Investigate and report multi-state work related incidents to the Third-Party Administrator. Coordinate initial work-related medical treatment. Act as a liaison between the employee and Third-Party Administrator. Process all related documentation. Work closely with the Third-Party Administrator and carrier to manage and monitor the claim file “cradle to grave” to ensure proper handling, reserve accuracy and evaluate settlement requests. Manage litigation process and defense counsel. Maintain relationships with in-network medical providers. Report all Monthly OCIP payroll for related projects. Maintain OSHA 300 log. Maintain various internal Excel spreadsheets and other reports. Attend offsite events if necessary (ex: court hearings, conferences, etc.). May also handle the overflow of minor General Liability and Auto Liability property damage claims at the direction of the Department Supervisor. Prior experience in this area is a plus, but not required as training will be provided. Other projects as directed by Management.
   City : Paramus Area
   State : NJ
   Requirement : Minimum of 7 years of adjusting Workers Compensation claims. Industry related professional certifications and education is a plus. Prior employment within the insurance industry with a carrier, TPA or broker is required. Must be able to work independently, as well as function as part of a team. Must be proficient in MS Excel, MS Word, Power Point and typing. Multi-jurisdictional knowledge is strong preferred; NJ, NY, PA, DE and MD are the primary venues. Strong negotiation skills. Experience with contracts and risk transfer. Familiarity with state statutes and case law. Manage loss costs and expenses. Litigation experience is required. Ability to handle sensitive information with high level of confidentiality. Time management and organization are extremely critical for this role. Writing - ability to prepare correspondence such as denials, demands and status reports. Ability to communicate in a positive and professional manner to employees and outside customers.
   Base Pay Low : $75,000
   Base Pay High : $85,000
           

 

Job Title : Workers Compensation Claims Examiner
   Jobcode : 21213
   Description : Investigate and report multi-state work related incidents to the Third-Party Administrator. Coordinate initial work-related medical treatment. Act as a liaison between the employee and Third-Party Administrator. Process all related documentation. Work closely with the Third-Party Administrator and carrier to manage and monitor the claim file “cradle to grave” to ensure proper handling, reserve accuracy and evaluate settlement requests. Manage litigation process and defense counsel. Maintain relationships with in-network medical providers. Report all Monthly OCIP payroll for related projects. Maintain OSHA 300 log. Maintain various internal Excel spreadsheets and other reports. Attend offsite events if necessary (ex: court hearings, conferences, etc.). May also handle the overflow of minor General Liability and Auto Liability property damage claims at the direction of the Department Supervisor. Prior experience in this area is a plus, but not required as training will be provided. Other projects as directed by Management.
   City : Paramus Area
   State : NJ
   Requirement : Minimum of 7 years of adjusting Workers Compensation claims. Industry related professional certifications and education is a plus. Prior employment within the insurance industry with a carrier, TPA or broker is required. Must be able to work independently, as well as function as part of a team. Must be proficient in MS Excel, MS Word, Power Point and typing. Multi-jurisdictional knowledge is strong preferred; NJ, NY, PA, DE and MD are the primary venues. Strong negotiation skills. Experience with contracts and risk transfer. Familiarity with state statutes and case law. Manage loss costs and expenses. Litigation experience is required. Ability to handle sensitive information with high level of confidentiality. Time management and organization are extremely critical for this role. Writing - ability to prepare correspondence such as denials, demands and status reports. Ability to communicate in a positive and professional manner to employees and outside customers.
   Base Pay Low : $75,000
   Base Pay High : $85,000