- Promptly investigate all assigned claims with minimal supervision, including those of a more complex Construction nature.
- Determine coverage, compensability, potential for subrogation recovery, and other offsets (when applicable).
- Alert Supervisor and carriers Special Investigations Unit to potentially suspect claims.
- Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
- Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
- Negotiate claims settlements with carriers approval.
- Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition.
- Work collaboratively with medical professionals to develop and execute return to work strategies.
- Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome.
- Maintain a working knowledge of New York State requirements and applicable case law for NY.
- Demonstrate technical proficiency through timely, consistent execution of best claim practices.
- Communicate effectively, verbally and in writing, with internal and external parties on a wide variety of claims and account issues.
- Provide a high degree of customer service to clients, including but not limited to day to day interactions, claims reviews and renewal meetings.
- Authorize medical treatment based on protocols established by NYS WC law
- Assist Underwriting on new and renewal business
- Claims Adjusters License required
- Bachelor's degree, or four or more years of equivalent work experience.
- At least 3 or more years' experience handling New York State lost time workers compensation construction claims for
- Associate in Claims (AIC) Designation or similar professional designation desired.
- Familiarity with medical terminology.
- Strong organizational skills and ability to manage multiple tasks simultaneously.
- Demonstrated ability to work independently and with a team.
- Ability to analyze data and make sound decisions.
- Strong verbal and written communication skills.
- Strong Knowledge of OSHA construction standards
- Knowledge of NYS labor Law §240
- Computer literacy, including working knowledge of MS Office products including Word, Excel and PowerPoint. Knowledge of Claim Center a plus.
- Ability to travel for business purposes, less than 15%.
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Claims Adjuster II - Syracuse, United States - The Amynta Group
Description
We're thrilled that you are interested in joining us here at the Amynta Group
As a member of Oryx Insurance Brokerage, Inc claims team, utilize knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex construction nature in order to achieve appropriate outcomes. In this position you will administer and resolve Workers Compensation claims in a timely manner in accordance with legal statues, policy provisions and carrier guidelines.
Responsibilities:
The Amynta Group (the "Company") is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of any ground of discrimination protected by applicable human rights legislation. The information collected is solely used to determine suitability for employment, verify identity and maintain employment statistics on applicants.
Applicants with disabilities may be entitled to reasonable accommodation throughout the recruitment process in accordance with applicable human rights and accessibility legislation. A reasonable accommodation is an adjustment to processes, procedures, methods of conveying information and/or the physical environment, which may include the provision of additional support, in order to remove barriers a candidate may face during recruitment such that each candidate has an equal employment opportunity. The Company will accommodate a candidate to the point of undue hardship. Please inform the Company's personnel representative if you require any accommodation in the application process.
