Position Summary
The Workers' Compensation Claims Examiner is responsible for managing complex or high-exposure workers' compensation claims, including those involving litigation and rehabilitation. This role ensures timely and appropriate claim resolution while adhering to statutory regulations, industry best practices, and client service standards.
Key Responsibilities
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Investigate and analyze complex claims to determine exposure and benefits due.
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Develop and execute action plans to resolve claims efficiently and effectively.
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Calculate and manage reserves and benefits; process payments and adjustments.
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Negotiate settlements within designated authority levels.
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Prepare and file required state documentation within statutory deadlines.
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Oversee the litigation process and coordinate with external vendors.
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Identify and pursue subrogation opportunities and recovery options.
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Communicate claim activity to claimants and clients while maintaining professional relationships.
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Ensure accurate documentation and coding of claim files.
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Comply with quality standards and company policies.
Qualifications
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NY Workers' Compensation License (Required)
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2–3 years of workers' compensation claims management experience (Required)
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Bachelor's degree from an accredited institution (Preferred)
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Strong knowledge of insurance principles, claim processes, and regulatory requirements
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Proficient in Microsoft Office; experience with claims systems preferred
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Excellent communication, negotiation, and organizational skills
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Ability to manage multiple priorities in a fast-paced environment
Work Environment
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Hybrid work setting with occasional travel
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Requires clear thinking, problem-solving, and the ability to meet deadlines
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Background credit check required
Nesco Resource offers a comprehensive benefits package for our associates, which includes a MEC (Minimum Essential Coverage) plan that encompasses Medical, Vision, Dental, 401K, and EAP (Employee Assistance Program) services.
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.