Worker’s Compensation Claims Examiner - Abela Staffing LLC

Job description

Investigate and manage workers' compensation claims in multiple jurisdictions.

Coordinate with nurse case managers, counsel, external vendors, and insureds for efficient claims handling.

Complete and document initial loss investigations to determine compensability.

Establish initial and subsequent reserves for anticipated exposure.

Review medical bills for causal relationship to reported claims.

Liaison with insureds, nurse case managers, and counsel to oversee claim management and facilitate return to work.

Develop and maintain action plans to ensure reserve adequacy and timely resolution of claims.

Negotiate settlement of claims within designated authority.

Prepare and present claim review summaries for insureds, brokers, and internal contacts as requested.

Participate in discussions with insureds and counsel on strategies for successful claim closure.

Provide guidance and assistance to insureds and brokers on timely reporting of claims.

Manage insured onboarding, including training on claims reporting and use of the insured portal.

Experience/ Qualifcations you will need:

Bachelor's degree preferred.

Professional designation such as CPCU, ARM, CRM, or similar preferred.

Proficient in Microsoft Office and adaptable to learn other software applications.

Excellent oral and written communication skills.

Detail oriented with a high accuracy rate.

Strong critical thinking and organizational skills.

Ability to problem-solve and use good judgment.

Self-motivated with excellent time management skills.

5+ years adjusting workers' compensation claims in multiple jurisdictions.

Experience in NY, NJ, and PA preferred, with NY experience required.

Healthcare industry experience preferred.

Construction industry experience preferred.

5-7 years experience as a Workers Comp loss time claim adjuster.