Associate, Claims Examiner
- Career Level
- Not Specified
York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies 2017" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.
Investigates in consultation with his or her manager claims of lesser value or complexity than those handled by Claims Examiners to make a recommendation concerning an injured workers entitlement to Workers Compensation benefits; Administers indemnity and medical benefits for valid Workers Compensation claims; manages a caseload of claims from inception to closing or settlement; Completes formal training program for consideration of advancement to Claims Examiner position. In performing these functions, the Claims Examiner Associate works to gain the training and experience to potentially function as an Examiner, Workers Compensation Claims.
Essential Duties and Responsibilities
All duties and responsibilities are essential job functions and are subject to possible modifications to reasonably accommodate individuals with disabilities.
- Participates in ongoing training sessions, both formal and informal, to include York requirements and state-specific statutory requirements
- Completes 3-point contact on new claims within 24 hours in order to obtain information necessary to make a compensability recommendation on the claim
- Investigates claims in consultation with manager; conducts witness interviews
- Works under the managers specific supervision to establishes appropriate reserve levels based on financial exposure and updates reserves upon receipt of new information
- Obtains manager approval for settlement and lien resolution
- Prepares claim status reports with significant input from manager
- Identifies potential fraud and obtains manager direction for addressing
- Provides support for litigation matters at direction of manager and/or defense attorney
- Authorizes medical treatment in consultation with manager
- Identifies subrogation potential and pursues reimbursement
- Calculates PD Ratings per AMA Guides
- Directs assistant to properly pay indemnity benefits and awards. Issues state-mandated benefit notices within the required timeframes
- Annotates, categorizes and addresses incoming mail on a daily basis
- Responds to questions and requests from the client
- Ensures claim files are properly documented
- Maintains professional client relationships and provides superior customer service
- Successfully completes all State mandated continuing education hours and obtains the necessary license or certification in accordance with State regulations.
- Evening or weekend courses/seminars may be required in order to meet certification/licensing requirements.
BS/BA or Equivalent Work Experience
0 to 2 years as a workers compensation claims adjuster
High School Diploma
BS/BA or Equivalent Work Experience
No prior related work experience is required
- Ability to prioritize multiple tasks and meet deadlines
- Excellent written and verbal skills
- Excellent customer service skills
- Good interpersonal skills
- Ability to work in a team environment
- Workers Compensation law, policies and procedures preferred
- Medical and legal terminology preferred
- Integration with Medicare preferred