Senior Claims Specialist
- 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.
The Senior Claims Specialist will manage claims as do our regular examiners. They investigate claims to determine an injured workers entitlement to Workers Compensation benefits. He/she administers indemnity and medical benefits for valid Workers Compensation claims and manages a caseload of claims from inception to closing or settlement. He/she assists Unit Manager with mentoring new claims examiner and/or supervisory functions.
The Senior Claims Specialist is given temporary assignments within the claims department. These assignments often stem from vacancies due to leaves, vacation, or resignations. The floating examiner can also be assigned to various initiatives within the claim department to include but not to be limited to the following: Auditing, preparing files for a claim review, preparing files for an audit, coding, model office testing, backlogged diary, and the like.
The Senior Claims Specialist will be given various types of temporary assignments as outlined above. The primary job responsibilities are as follows:
Completes 3-point contact on new claims within 24 hours in order to obtain information necessary to make a compensability decision on the claim
Establishes appropriate reserve levels based on financial exposure and updates reserves upon receipt of new information.
Directs assistant to properly pay indemnity benefits payments 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
Ability to prioritize multiple tasks and meet deadlines
Excellent written and verbal skills
Excellent customer service skills
Must remain flexible as assignments vary
Certifications to include SIP or the equivalent
Workers Compensation law specific to assigned jurisdiction; policies and procedures
Medical and legal terminology, Integration with Medicare
Public Entity experience highly desired
BS / BA or Equivalent Work Experience
5 to 8 years Workers Compensation claims handling