Talent.com
NY LT Wokers Compensation Claims Examiner
NY LT Wokers Compensation Claims ExaminerHighview National Insurance Company • Rockland County, NY, US
NY LT Wokers Compensation Claims Examiner

NY LT Wokers Compensation Claims Examiner

Highview National Insurance Company • Rockland County, NY, US
30+ days ago
Job type
  • Full-time
  • Quick Apply
Job description

Worker’s compensation insurance is a headache.

We make it simple, smooth, and stress free.

Join us in redefining workers’ comp.

Job Summary :

  • The Workers’ Compensation Claims Examiner is responsible for the investigation, evaluation, and management of lost time workers’ compensation claims.
  • This role involves overseeing medical and litigation management to drive timely claim resolutions while actively mitigating risk and financial exposure for the company.
  • This document serves as a Guideline and your activities should not limited to only these activities.  The Claims Examiner will collaborate with nurse case managers, legal counsel, external vendors, and insureds to ensure efficient, proactive claims handling.
  • This position requires strong analytical skills, adaptability, and the ability to navigate evolving workers’ compensation laws and processes effectively.

Essential Job Functions :

  • Conduct and document thorough loss investigations to determine compensability.
  • Establish and adjust reserves to align with anticipated exposure.
  • Review medical bills to confirm causal relationship to claims.
  • Collaborate with insureds, nurse case managers, and legal counsel to facilitate claim resolution and return-to-work processes.
  • Develop action plans to maintain reserve adequacy and ensure timely settlements.
  • Negotiate claim settlements within designated authority.
  • Prepare and present claim review summaries to stakeholders.
  • Participate in strategy discussions to drive successful claim outcomes.
  • Guide insureds and brokers on timely claim reporting and best practices.
  • Oversee insured onboarding and training for claims reporting and portal use.
  • Required Skills / Abilities :

  • Excellent oral and written communication skills —able to convey complex information effectively.
  • Detail-oriented with a high accuracy rate , ensuring precision in claim processing.
  • Strong critical thinking and problem-solving skills to assess claims efficiently and make informed decisions.
  • Flexible and tech-savvy , comfortable navigating various software tools and adapting to new processes.
  • Highly adaptable , able to adjust to evolving laws and industry changes with ease.
  • Thrives in a dynamic environment —willing to embrace change and contribute to continuous improvement.
  • Self-motivated with excellent time management , capable of handling multiple priorities effectively.
  • Education and Experience :

  • Bachelor’s degree preferred Professional designation such as AIC or CPCU preferred Examiner license required 5-7 years adjusting lost time worker’s compensation claims   NY experience required.
  • Physical Requirements :

  • Prolonged periods sitting at a desk and working on a computer.
  • Prolonged periods of standing, walking, and / or sitting and reaching with hands and arms.
  • Must be able to lift 10 pounds at a time.
  • Additional Requirements :

  • Due to the nature of our business, and urgency of our clients' needs, you may be required to participate in the Company’s on call program and work on holidays / weekends according to the on-call schedule.
  • This is an in-office role We are an Equal Opportunity Employer We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation.

  • We intend that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.   Powered by JazzHR
  • Create a job alert for this search

    Claim Examiner • Rockland County, NY, US

    Related jobs
    Senior Claims Examiner I

    Senior Claims Examiner I

    AmTrust Financial • New York, NY, United States
    Full-time
    The Workers Comp Adjuster III is responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interac...Show more
    Last updated: 30+ days ago • Promoted
    Senior General Liability Bodily Injury Technical Claims Specialist

    Senior General Liability Bodily Injury Technical Claims Specialist

    Argonaut Management Services, Inc • New York, NY, United States
    Full-time
    Argo Group International Holdings, Inc.American National, US based specialty P&C companies, (together known as BP&C, Inc. Brookfield Wealth Solutions, Ltd.BWS"), a New York and Toronto-listed public...Show more
    Last updated: 30+ days ago • Promoted
    Earn up to $25 per survey Online Survey Taker - Work from Home with Fortune 500 Companies (Hiring Immediately)

    Earn up to $25 per survey Online Survey Taker - Work from Home with Fortune 500 Companies (Hiring Immediately)

    Earn Haus • Woodbury, New York, US
    Remote
    Full-time +1
    We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up...Show more
    Last updated: 30+ days ago • Promoted
    Claims Adjustment Specialist I

    Claims Adjustment Specialist I

    MetroPlus Health Plan • New York, NY, United States
    Full-time +1
    Claims Adjustment Specialist I.Water Street, 7th Floor, New York, NY 10004 .New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege.If you have co...Show more
    Last updated: 30+ days ago • Promoted
    Earn up to $25 per survey Online Survey Taker - No experience required (Hiring Immediately)

    Earn up to $25 per survey Online Survey Taker - No experience required (Hiring Immediately)

    Earn Haus • Haverstraw, New York, US
    Full-time +1
    We are urgently looking for people interested in taking online surveys for Fortune 500 brands.If you are a self-starter, looking for flexible hours throughout the week, this may be for you! Earn up...Show more
    Last updated: 30+ days ago • Promoted
    General Liability Claims Adjuster

    General Liability Claims Adjuster

    Reserv • Bronx, NY, US
    Full-time
    General Liability Claims Adjuster.Reserv is an insurtech creating and incubating cutting-edge AI and automation technology to bring efficiency and simplicity to claims. Founded by insurtech veterans...Show more
    Last updated: 24 days ago • Promoted
    Travel-LPN-Croton on Hudson, NY

    Travel-LPN-Croton on Hudson, NY

    NursingPro Staffing • Croton-on-Hudson, NY, United States
    Full-time
    About the job Travel-LPN-Croton on Hudson, NY.A great opportunity is at your fingertips!.Reasons You Should Join Us Today! Discover exciting BENEFITS : . Exclusive Discounts to shopping, theme parks, ...Show more
    Last updated: 19 days ago • Promoted
    Liability Adjuster

    Liability Adjuster

    HDVI • Bronx, NY, US
    Full-time
    High Definition Vehicle Insurance Claims / Full-Time Remote.High Definition Vehicle Insurance (HDVI) : Technology meets Insurance. HDVI brings telematics, software and data together with commercial ...Show more
    Last updated: 8 days ago • Promoted
    Claims Examiner, Bodily Injury | Liability | Remote

    Claims Examiner, Bodily Injury | Liability | Remote

    Remote Staffing • New York, NY, US
    Remote
    Full-time
    Claims Examiner, Bodily Injury | Liability | Remote.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who ar...Show more
    Last updated: 18 hours ago • Promoted • New!
    Medical Record Clerk

    Medical Record Clerk

    TEKsystems • Woodbury, NY, United States
    Full-time
    Handle and respond promptly to inquiries from clients and / or anyone acting on behalf of the client regarding questions, report status, concerns, or general requests for information.Utilize appropri...Show more
    Last updated: 3 days ago • Promoted
    Liability Claims Examiner - NY

    Liability Claims Examiner - NY

    GNY Insurance Companies • New York, NY, United States
    Full-time
    NEW YORK HEADQUARTERS - NEW YORK, NY.To examine, adjust, defend, claims and lawsuits against our insureds.In entails reviewing policies to determine coverage, resolving questions of coverage, inves...Show more
    Last updated: 8 days ago • Promoted
    Claim Specialist - Property Field Inspection

    Claim Specialist - Property Field Inspection

    State Farm • Nanuet, NY, United States
    Full-time
    US-NY-Nanuet;US-NY-Suffern;US-NJ-Norwood;US-NJ-Mahwah;US-NY-Newburgh.Being good neighbors - helping people, investing in our communities, and making the world a better place - is who we are at Stat...Show more
    Last updated: 4 days ago • Promoted
    Associate, Patient Accounts III

    Associate, Patient Accounts III

    Montefiore St. Luke's Cornwall • Cornwall, NY, United States
    Full-time
    Responsible for accurate and timely follow up on all primary and secondary insurance balances to ensure payments are received in accordance to the Payer policy and / or Hospital contracts.High School...Show more
    Last updated: 16 days ago • Promoted
    Custom Liability Claims Examiner

    Custom Liability Claims Examiner

    GNY Insurance Companies • New York, NY, United States
    Full-time
    NEW YORK HEADQUARTERS - NEW YORK, NY.To handle claims associated with GNY Custom book and other select accounts from inception to closure. To assure that there are accurate reserve and expense contr...Show more
    Last updated: 8 days ago • Promoted
    Insurance Examiner / NYC, NY / Hybrid

    Insurance Examiner / NYC, NY / Hybrid

    AV Staffing Solutions • New York, NY, us
    Full-time
    Quick Apply
    Seeking an Exceptional Insurance Examiner to Join Our Client's Dynamic Team! .Are you meticulous, detail-oriented, and thrive in a fast-paced environment? We are currently seeking an .Per...Show more
    Last updated: 30+ days ago
    Unknown Job

    Unknown Job

    Hudson Regional Hospital • Clifton, NJ, US
    Full-time
    Director Of Revenue Cycle Management.Hudson Regional Hospital is currently seeking a Director of Revenue Cycle Management. The Director for Revenue Cycle Management ("Director") is responsible for o...Show more
    Last updated: 30+ days ago • Promoted
    New York PIP Litigation Examiner - National General

    New York PIP Litigation Examiner - National General

    Allstate Insurance • New York, NY, United States
    Full-time
    National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers' evolving needs. We offer home, auto and accident an...Show more
    Last updated: 5 days ago • Promoted
    CA Senior Claims Specialist

    CA Senior Claims Specialist

    CorVel • Bronx, NY, US
    Full-time
    The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determin...Show more
    Last updated: 24 days ago • Promoted