Claims Adjuster II

Job Description: • 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 Requirements: • 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 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% Benefits: • Health insurance • 401(k) matching