Claims Examiner - Workers Compensation

Claims Examiner - Workers Compensation

BCforward is currently seeking a highly motivated Claims Examiner - Workers Compensation for an opportunity in Melville, NY 11747 (Hybrid)!

Position Title: [Claims Examiner - Workers Compensation]

Location: [Melville, NY 11747 (Hybrid)]

Anticipated Start Date: [05/05/2025]

Please note this is the target date and is subject to change. BCforward will send official notice ahead of a confirmed start date.

Expected Duration: [3 Months Contract]

Job Type: [FULL TIME (>%3D30 HRS WEEKLY)/PART TIME (<30 HRS WEEKLY)], [CONTRACT], [HYBRID]

Pay Range: [$40] - [$45]

Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Requirements:

• Experience in workers' compensation laws and insurance principles.
• NY License.

Job Description:

Position Overview:

To analyze complex and technically challenging workers' compensation claims to determine benefits due. This includes handling high-exposure claims involving litigation and rehabilitation. The role ensures ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements. Identification of subrogation opportunities and settlement negotiation is also required.

Essential Functions and Responsibilities

• Analyze and process complex workers' compensation claims by gathering relevant information to assess exposure.
• Develop and manage action plans for timely and appropriate claim resolution.
• Negotiate settlements within authority limits.
• Calculate and maintain appropriate reserves throughout the claim lifecycle.
• Ensure timely payment of benefits and necessary adjustments.
• Prepare and file state-mandated documents within statutory timelines.
• Oversee and manage the litigation process to ensure effective resolution.
• Coordinate with vendors for investigations and litigation support.
• Implement cost containment techniques to minimize claim expenses.
• Handle claim recoveries, including subrogation, Second Injury Fund, Social Security, and Medicare offsets.
• Report claims to excess carriers and respond to direction requests promptly.
• Maintain effective communication with claimants and clients, ensuring strong professional relationships.
• Document claim files thoroughly and ensure accurate coding.
• Refer complex or significant cases to supervisors as needed.

Additional Responsibilities

• Perform other duties as assigned.
• Support organizational quality programs.
• Travel as required.

Qualifications

Education & Licensing

• Bachelor's degree from an accredited institution preferred.
• Professional certification relevant to the line of business is a plus.

Experience

• Minimum of 5 years in claims management or an equivalent combination of education and experience.

Skills & Knowledge

• In-depth knowledge of workers' compensation laws and insurance principles.
• Understanding of recoveries, offsets, medical management, Social Security, and Medicare procedures.
• Strong communication and presentation abilities.
• Proficiency in Microsoft Office and general PC use.
• Strong analytical and organizational skills.
• Effective interpersonal and negotiation skills.
• Team player with the ability to meet or exceed service expectations.

Work Environment

Mental Requirements:

• Strong conceptual thinking, problem-solving, discretion, and multitasking skills.
• Ability to manage work-related stress and meet deadlines.

Physical Requirements:

• Standard computer use and travel as necessary.

Benefits:

BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

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About BCforward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 237998 when responding to this ad.

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