Workers Compensation Claims Examiner III

Location: Pennsylvania -- Hybrid
Jurisdiction: New York

About the Opportunity

Our client is seeking an experienced Workers Compensation Claims Examiner III to independently manage complex New York workers' compensation indemnity claims from inception through resolution.

This position offers responsibility for a caseload of approximately 115-125 files, including very complex claims. The successful candidate will bring strong technical judgment, confident client communication, and the ability to manage investigations, benefits, reserves, medical treatment, litigation, and settlements with minimal supervision.

This is a hybrid position tied to a Pennsylvania office and requires regular, reliable in-office attendance. An active license to handle New York claims is required.

Responsibilities

• Independently manage approximately 115-125 workers' compensation claims, including very complex New York indemnity files.

• Initiate timely investigations, evaluate claim facts, and determine compensability under applicable state law and company guidelines.

• Administer benefits accurately and manage claims within established authority.

• Coordinate medical treatment and medical billing, providing authorization as appropriate.

• Refer claims to defense counsel and actively direct litigation strategy and case progress.

• Establish, evaluate, and update reserves based on claim exposure and company guidelines.

• Negotiate settlements and resolve claims within designated authority, obtaining additional approval when required.

• Maintain accurate claim documentation and a consistent diary system to support timely follow-up.

• Communicate clearly with claimants, clients, medical providers, vendors, counsel, and internal team members.

• Conduct independent file reviews and provide clients with timely, substantive claim updates.

• Identify injury trends and safety concerns, involving loss control resources when appropriate.

• Follow company policies, procedures, and claims-handling standards.

Qualifications

• Three or more years of related claims experience, or an equivalent combination of education and experience.

• Active license to handle claims in New York.

• Demonstrated ability to independently manage complex workers' compensation indemnity claims.

• Working knowledge of New York workers' compensation requirements, statutory regulations, and medical terminology.

• Experience evaluating compensability, establishing reserves, managing litigation, and resolving claims.

• Strong analytical, organizational, and decision-making skills.

• Excellent written and verbal communication skills, including the ability to explain technical claim matters clearly.

• Ability to collaborate professionally with clients, claimants, colleagues, and outside service providers.

• Ability to meet the Pennsylvania office's hybrid attendance requirements.

• Bachelor's degree in a related field preferred.

• Proficiency in Microsoft Word and Excel preferred.

Apply

Please submit your resume highlighting your New York workers' compensation claims experience, complex indemnity caseload responsibilities, and current claims license.