-
Claims Examiner
1 week ago
Sedgwick Claims Management Services Syracuse, United StatesWe are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion. ARE YOU AN IDEAL CANDIDATE? To analyze workers compensation claims on behalf of our Workers Compensation, Claims, ...
-
Claims Examiner
3 weeks ago
Sedgwick Syracuse, United StatesTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
-
Claims Examiner
1 week ago
Sedgwick Syracuse, United StatesTaking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportuni ...
-
Claims Examiner
3 weeks ago
LanceSoft Syracuse, United StatesThis is remote role · Primary Purpose: Analyse complex or technically difficult workers' compensation claims to determine benefits due. · Work with high exposure claims involving litigation and rehabilitation. · Ensure ongoing adjudication of claims within service expectations, i ...
-
Claims Examiner
3 weeks ago
ICONMA Syracuse, United States: · Primary Purpose: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry be ...
-
Claims Examiner
2 weeks ago
LanceSoft Syracuse, United StatesJob Responsibilites: · Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolut ...
-
Claims Assistant
1 week ago
CorVel Corporation Syracuse, United States Full timeJOB SUMMARY: · Assist and support the claims staff in the set-up and administration of workers' compensation claims/case management and other tasks depending on the specific needs of the customers. This position is in office. · ESSENTIAL JOB DUTIES: · Sets up new claims · Proce ...
-
Office Administrator-Syracuse, NY
5 days ago
Masis Professional Group Syracuse, United StatesOffice Administrator (Operations) · Syracuse, NY · Job description · **This is a contract role, with the possibility of extension, and temp-to-hire.** · Job Overview: · The Office Administrator (Operations Specialist) is responsible for operational support duties such as proces ...
-
Masis Professional Group Syracuse, United StatesOperations Administrative Assistant · Syracuse, NY · Job description · **This is a contract role, with the possibility of extension, and temp-to-hire.** · Job Overview: · The Office Administrator (Operations Administrative Assistant) is responsible for operational support dutie ...
-
Resources Reimbursement Agent 1, Central Office;
3 weeks ago
StateJobsNY Syracuse, United StatesNon-Competitive HELPS: · Trainee 1: A bachelor's or higher degree OR · Trainee 2: A bachelor's or higher degree and one year of professional experience OR A Juris Doctor, master's or higher degree · Journey Level: A bachelor's degree or higher and two years of professional exp ...
-
State of New York Syracuse, United StatesPlease note: State agencies that contact job applicants do not usually request personal or financial information via text message or over the phone in connection with your response to a job posting. If you are contacted for such information by these methods, or any other method, ...
-
psychologist in syracuse ny
3 weeks ago
The IMA Group Syracuse, NY, United States· Company Overview: · For over 30 years, The IMA Group has been dedicated to enhancing the livelihood and productivity of individuals and organizations navigating challenging periods of health, work and disability while actively contributing to the development of new medical tre ...
-
Licensed Psychologist in Syracuse
1 week ago
The IMA Group Syracuse, United States· Job Title: Licensed Psychologist - PhD or PsyD (Independent Contractors, Part time, Full time) - Syracuse · Company Overview: · For over 30 years, The IMA Group has been dedicated to enhancing the livelihood and productivity of individuals and organizations navigating challeng ...
-
Dentist
6 days ago
Veterans Affairs, Veterans Health Administration Syracuse, United StatesSummary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual eligibility requirements in accordance with VHA policy and submit your EDRP application within four months of appoint ...
-
Resources Reimbursement Agent 1, Central Office;
3 weeks ago
New York State Civil Service Syracuse, United StatesNY HELP Yes · Agency Mental Health, Office of · Title Resources Reimbursement Agent 1, Central Office; · Occupational Category Financial, Accounting, Auditing · Salary Grade 18 · Bargaining Unit PS&T - Professional, Scientific, and Technical (PEF) · Salary Range From $65001 to $8 ...
-
Dentist
5 days ago
Veterans Health Administration Syracuse, United StatesSummary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual eligibility requirements in accordance with VHA policy and submit your EDRP application within four months of appoint ...
-
Anesthesiologist
2 weeks ago
Veterans Affairs, Veterans Health Administration Syracuse, United StatesSummary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual eligibility requirements in accordance with VHA policy and submit your EDRP application within four months of appoint ...
-
Auditor Trainee 1
3 weeks ago
StateJobsNY Syracuse, United StatesCOMPETITIVE MINIMUM QUALIFICATIONS · The selected candidate must be reachable on the eligible list for this title and location under Civil Service Law, Rules and Regulations. · OR · The selected candidate must be eligible for a 70.1 transfer under Civil Service Law, Rules and ...
-
Auditor Trainee 1
1 week ago
State of New York Syracuse, United StatesPlease note: State agencies that contact job applicants do not usually request personal or financial information via text message or over the phone in connection with your response to a job posting. If you are contacted for such information by these methods, or any other method, ...
-
Professional Engineer 1
3 weeks ago
StateJobsNY Syracuse, United StatesThis title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS).* · To be considered for appointment through NY HELPS, or 55 b/c, candidates must meet the open-competitive minimum qualifications for this position. The qualifications are: · ...
Claims Examiner - Syracuse, United States - NESCO Inc
Description
PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
Negotiates settlement of claims within designated authority.Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
Prepares necessary state fillings within statutory limits.Manages the litigation process; ensures timely and cost effective claims resolution.
Coordinates vendor referrals for additional investigation and/or litigation management.
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
Ensures claim files are properly documented and claims coding is correct.
Refers cases as appropriate to supervisor and management.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Travels as required.
Education & Licensing
Bachelor's degree from an accredited college or university preferred
Candidate must have a valid NY Adjuster's License
Experience
Three (3) years of claims management experience or equivalent combination of education and experience required.
Skills & Knowledge
Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
Excellent oral and written communication, including presentation skillsPC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Good interpersonal skills
Excellent negotiation skills
Ability to work in a team environment
Ability to meet or exceed Service Expectations
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental:
Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical:
Computer keyboarding, travel as required
Auditory/Visual:
Hearing, vision and talking
NOTE:
Credit security clearance, confirmed via a background credit check, is required for this position.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description
They are not intended to constitute a comprehensive list of functions, duties, or local variances
Management retains the discretion to add or to change the duties of the position at any time.
Nesco Resource provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
