NY LT Wokers Claims Examiner

Overview

Worker’s compensation insurance is a headache. We make it simple, smooth, and stress free. Join us in redefining workers’ comp.

The Workers’ Compensation Claims Examiner is responsible for the investigation, evaluation, and management of lost time workers’ compensation claims. This role involves overseeing medical and litigation management to drive timely claim resolutions while actively mitigating risk and financial exposure for the company. This document serves as a Guideline and your activities should not be limited to only these activities.

The Claims Examiner will collaborate with nurse case managers, legal counsel, external vendors, and insureds to ensure efficient, proactive claims handling. This position requires strong analytical skills, adaptability, and the ability to navigate evolving workers’ compensation laws and processes effectively.

• Conduct and document thorough loss investigations to determine compensability.
• Establish and adjust reserves to align with anticipated exposure.
• Review medical bills to confirm causal relationship to claims.
• Collaborate with insureds, nurse case managers, and legal counsel to facilitate claim resolution and return-to-work processes.
• Develop action plans to maintain reserve adequacy and ensure timely settlements.
• Negotiate claim settlements within designated authority.
• Prepare and present claim review summaries to stakeholders.
• Participate in strategy discussions to drive successful claim outcomes.
• Guide insureds and brokers on timely claim reporting and best practices.
• Oversee insured onboarding and training for claims reporting and portal use.

• Excellent oral and written communication skills — able to convey complex information effectively.
• Detail-oriented with a high accuracy rate — ensuring precision in claim processing.
• Strong critical thinking and problem-solving skills — to assess claims efficiently and make informed decisions.
• Flexible and tech-savvy — comfortable navigating various software tools and adapting to new processes.
• Highly adaptable — able to adjust to evolving laws and industry changes with ease.
• Thrives in a dynamic environment — willing to embrace change and contribute to continuous improvement.
• Self-motivated with excellent time management — capable of handling multiple priorities effectively.

• Bachelor’s degree preferred
• Professional designation such as AIC or CPCU preferred
• Examiner license required
• 5-7 years adjusting lost time worker’s compensation claims
• NY experience required

• Prolonged periods sitting at a desk and working on a computer.
• Prolonged periods of standing, walking, and/or sitting and reaching with hands and arms.
• Must be able to lift 10 pounds at a time.

• Due to the nature of our business, and urgency of our clients  needs, you may be required to participate in the Company’s on call program and work on holidays/weekends according to the on-call schedule.
• This is an in-office role

We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. We intend that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.