Claims Examiner

Position Summary:
A worker's compensation claims adjuster is responsible for planning and scheduling the work required to process a claim. Investigation, consulting with other professionals and ensure proper guidelines are followed to mitigate exposure on the claim.

Essential Duties and Responsibilities:
• Responsible for day-to-day handling of mostly small to medium workers compensation claims files according to the established claim guidelines and procedures and to provide the best possible claim service

• Ensure and confirm or deny coverage and compensability of claims presented through investigation and contact with claimant, insured and other involved parties.

• Establish appropriate case reserves based on specifics of case according to company guidelines and processes and applicable state requirements.

• Review and make appropriate decisions regarding medical bills, wage claims and other daily claims items to keep file up-to-date.

• Identify subrogation opportunities and refer to appropriate internal or external parties to handle.

• Refer file to appropriate parties for medical management, special investigative needs, etc. and monitor status of work performed.

• Manage files in litigation and review quality of outside counsel participation.

• Negotiate claims as needed within assigned authority levels.

• Ensures compliance with material within procedural guidelines.

Required Education and Experience:
High school diploma is necessary. An associate’s degree or related on the job experience of no less than three years. An Independent Adjusters license is preferred but not necessary.

Physical Demands and Working Conditions:
Normally, physical demands are typical of an office environment.

To apply, please send your resume, along with the position you are applying for, to:

Rand Building, Suite 700
14 Lafayette Square
Buffalo, NY 14203
Attn: Human Resources