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Syracuse

    Claims Examiner - Syracuse, United States - LanceSoft

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    Description

    Job 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 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.


    Requirements:

    Work Location:
    Yes we prefer Syracuse but we will consider remote
    Candidate must have a valid NY Adjuster's License
    Minimum 2 years of relevant experience handling NY Worker's Compensation lost time claims.
    Education & Licensing
    Bachelor's degree from an accredited college or university preferred. Candidate must have a valid NY Adjuster's License
    Three (3) years of claims management experience or equivalent combination of education and experience required.

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