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Examiner Senior Workers Compensation Claims (Salary)

Employer
York Risk Services Group
Location
Albany, New York
Salary
Not Specified
Closing date
Mar 12, 2019

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Category
Claims, Workers' Compensation
Job Type
Not Specified
Career Level
Not Specified

Job Details

At York, we believe that an experience marked by expertise, consistency and compassion sets us apart. And we celebrate the diverse backgrounds and unique perspectives that allow us to stand apart from our competitors. Thats why we are committed to recruiting, developing and retaining people who represent our values and who believe in our mission.

Job Description

  • Assume leadership role in the organization, complying with and assisting management in the administration of organization processes. Assist in the implementation of new processes and makes suggestions for improvements. Supports and helps Claims Management in its initiatives. Mentors other adjusters within the team. Helps coordinate service to members assigned with the team.
  • The Claim Specialist will produce work of the highest quality. Files will demonstrate detailed investigation, analysis and evaluation of the most complex lost time cases through telephone or personal interviews with the injured employee, employer and all other pertinent parties. Documentation as the file unfolds is detailed, with proper action plans recorded. Continues to gather all pertinent data as long as claim file remains active.
  • Evaluate data for compensability and establishes accurate case reserve based on approved reserving procedures. Reacts to events as they unfold in the file with proper reserve changes without fail. Properly completes Claim Summary Reports in a timely manner. Excellent negotiation skills, able to produce Section 32 settlements and claim stipulations as needed.
  • Provide data to Case Management Team members and assists in the development of a treatment and return to work plan. Responsible for the implementation of the plan in conjunction with the Patient Advocate.
  • Responsible for compliance with all regulations from the Workers Compensation Board including timely EDI and compliance reporting requirements and resolution of any EDI and/or compliance issues. Expert knowledge of Disability and Medical Treatment Guidelines. Mentor other case analysts for understanding and compliance to regulations and laws.
  • Responsible for each cases compliance with established service standards. Exemplary usage of best practices.
  • Organize each workload so that all cases receive the proper claims handling and are promptly brought to a conclusion.
  • Assist in the training, development and orientation of the Case Analysts.
  • Assist in handling administrative issues that arise in the claims team environment.
  • Represent the company at meetings and presentations.
  • Understands and works within PERMAs Core Beliefs.
  • Takes a proactive approach to office safety and ergonomics and adheres to all safety policies.

Non-Essential Job Functions:

  • May act in a supervisory capacity in the absence of the Senior Claims Manager.
  • Perform other duties as assigned.

Minimum Requirements:

The following are required to enable the employee to perform the essential functions of the job:

Skills/knowledge

  • Displays high level of professional acumen needing minimal direction.
  • Excellent leadership ability. Exceptional communication and negotiation skills required.
  • Good analytical ability combined with common sense and the ability to empathize with those in traumatic situations.
  • Maintain the highest standards for the fair handling of claims.
  • Develop strong, outgoing business relationships with employers and employees.
  • Ability to work as a member of a team and to work with team until task is completed.

Experience/education

  • Preferably at least 5 years lost time claims experience.
  • Must be a seasoned claims professional with prior experience in dealing with more complex claims.

Company

For more than 55 years, York has been delivering on our mission of reducing risk and getting people and organizations back to health, work and productivity. We’re committed to recruiting, developing and retaining people who represent our values and who believe in our mission. Our associates come from all walks of life but are single-minded in the pursuit of doing right by those we serve. We want each experience for our clients to be marked by expertise, consistency, and compassion because that’s what sets us apart. And we know for certain that it’s our people who allow us to say, boldly and proudly, that York is behind every good outcome.

Company info
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