Workers Compensation Claims Representative | NY Jurisdiction & NY Licensing Required

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 are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

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Workers Compensation Claims Representative | NY Jurisdiction & NY Licensing Required

We are seeking a highly motivated and experienced Workers' Compensation Claims Representatives to join our team. The ideal candidate will have at least 2 years of claims handling experience, with a strong background in New York jurisdictional regulations and processes. This position is responsible for managing and processing workers' compensation claims, ensuring timely and accurate decisions while adhering to all applicable laws and regulations.

We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.

ESSENTIAL RESPONSIBILITIES

• Independently handle a capped caseload of workers' compensation claims, from inception to resolution, ensuring adherence to company procedures, industry best practices, and regulatory requirements.

• Ensure compliance with New York workers' compensation laws, including timely filing of reports, adherence to benefit payment timelines, and compliance with statutory requirements.

• Negotiate settlements of claims within designated authority to reach claim resolution.

• Provide clear and effective communication with the claimant and client.

• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

• Maintain accurate and comprehensive records in the claims management system, documenting all actions, decisions, and correspondence related to each claim.

QUALIFICATIONS

• Experience:

  • Minimum of (2) years of workers' compensation claims handling experience.

  • Experience specifically with New York jurisdictional regulations, including knowledge of New York State Workers' Compensation Board rules and procedures.

  • Experience with Public Entity claims management.

• Education:

  • High school diploma or equivalent; a college degree or relevant certifications (e.g., WCCP, AIC) is a plus.

• Skills and Abilities:

  • Strong understanding of workers' compensation claims processes, policies, and legal requirements in New York.

  • Excellent written and verbal communication skills.

  • Strong analytical skills with attention to detail and accuracy.

  • Ability to manage multiple claims simultaneously and prioritize workload effectively.

  • Proficiency with claims management software and Microsoft Office Suite (Excel, Word, Outlook).

  • Ability to negotiate settlements and resolve claims disputes effectively.

TAKING CARE OF YOU

• Flexible work schedule. 

• Referral incentive program. 

• Opportunity to work in an agile or remote environment.

• Career development and promotional growth opportunities. 

• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

WORK ENVIRONMENT REQUIREMENTS INCLUDE  
When applicable and appropriate, consideration will be given to reasonable accommodations. 

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines 

Physical: Computer keyboarding

Auditory/Visual: Hearing, vision and talking 

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($60k-$70k). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

#claimsexaminer #claims #hybrid #remote

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.