Workers Compensation Claims Examiner | NY License

Insurance Placement Solutions (IPS) has an immediate opening for a Workers’ Compensation Claims Examiner with our client in Philadelphia, Pennsylvania. This is a direct-hire opportunity requiring experience handling New York workers’ compensation claims and an active New York Workers’ Compensation Adjuster License. A hybrid work arrangement is preferred, although fully remote candidates may be considered if they reside outside the greater Philadelphia area.

In this role, you’ll independently manage a caseload of New York workers’ compensation claims for a variety of clients. You’ll investigate claims, determine compensability, administer benefits, coordinate medical treatment, establish reserves, and develop claim resolution strategies while ensuring compliance with New York workers’ compensation regulations and client requirements.

Workers’ Compensation Claims Examiner Responsibilities

• Manage a caseload of approximately 115–125 New York workers’ compensation claims
• Investigate claims and determine compensability in accordance with New York workers’ compensation requirements
• Calculate and administer workers’ compensation benefits within designated authority
• Coordinate medical treatment and monitor claim developments
• Establish, evaluate, and maintain appropriate claim reserves
• Develop claim strategies and action plans to support timely resolution
• Coordinate with defense counsel on litigated claims, when applicable
• Evaluate claim exposure and negotiate settlements within designated authority
• Coordinate return-to-work efforts with employers, medical providers, and other stakeholders
• Maintain accurate claim documentation and timely diary management
• Communicate claim developments with claimants, employers, attorneys, medical providers, and clients
• Participate in claim-file reviews and ensure compliance with applicable regulations and client handling instructions

Qualifications

• 3–5 years of workers’ compensation claims handling experience
• Direct experience handling New York workers’ compensation claims
• Strong knowledge of New York workers’ compensation laws, regulations, and benefit requirements
• Experience independently managing claims involving compensability, medical treatment, reserves, and resolution
• Ability to manage an active claims inventory and meet applicable deadlines

Licensing & Certifications

• Active New York Workers’ Compensation Adjuster License required

Work Arrangement

• Hybrid work arrangement preferred for candidates in the greater Philadelphia area
• Fully remote candidates may be considered if residing outside the greater Philadelphia area

About Insurance Placement Solutions

Insurance Placement Solutions is a staffing and recruiting firm specializing in the insurance industry. We connect talented professionals with temporary, temp-to-hire, and direct-hire opportunities at leading insurance organizations across the United States.

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