Overview Job Description Workers’ Compensation Disability Claims Specialist – NY PPD/Pension Responsibilities Manage a caseload of complex workers' compensation claims, focusing on NY PPD and pension claims. Evaluate claim information to determine liability, compensability, and appropriate benefit levels per New York Workers’ Compensation laws and regulations. Analyze medical reports, employment records, wage verification, and other relevant documentation to support claim decisions. Maintain communication with claimants, attorneys, medical professionals, and employers to ensure timely and accurate claim resolution. Calculate and process indemnity payments, settlements, and pensions per legal requirements and internal guidelines. Monitor changes in workers' compensation rules, case law, and employer policies for accurate claims handling. Negotiate settlements effectively and ethically, ensuring fair outcomes. Keep accurate and detailed files, documenting all claim activities in the claims management system. Assist claimants during the claims process, explaining policies and procedures. Collaborate with internal teams, such as legal and compliance, to address disputed or litigated claims. Identify opportunities for cost containment while committing to fair claim resolution. Qualifications/Requirements Experience 3-5 years of experience as a Claims Adjuster, specifically in New York Workers’ Compensation claims. Expertise in handling NY PPD and pension claims. Education High school diploma or GED required; preferred college degree or industry certifications (e.g., AIC, CPCU). Knowledge Comprehensive understanding of New York Workers’ Compensation laws, regulations, and case law. Familiarity with medical terminology, billing practices, and disability ratings. Skills Strong analytical and decision-making abilities. Excellent verbal and written communication skills. Proficiency with claims management systems and standard office software (e.g., MS Office Suite). Personal Attributes Detail-oriented, organized, and able to prioritize work in a fast-paced environment. Customer-focused with a dedication to service excellence. Capable of working independently while effectively collaborating with team members. Licenses/Certifications Active New York Adjuster License or the ability to obtain one within a designated timeframe. #J-18808-Ljbffr The Jonus Group
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