Claim Specialist I – IV, New York WC Claims

MEMIC

Claim Specialist focusing on New York WC claims; facilitating resolutions and managing key stakeholder communications. Evaluate and negotiate claims effectively in a fast-paced environment.

Posted 6/25/2026full-timeRemote • New York • 🇺🇸 United StatesJunior💰 $65,000 - $98,500 per yearWebsite

About the role

Key responsibilities & impact

Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure.
Administers the delivery of timely, appropriate and accurate indemnity and medical benefits.
Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.
Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate.
Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.
Serves as a mentor and helps prepare/train the less experienced Claim Department representatives.
Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.
Prepares and presents files for Agent/Broker Reviews and Insured File Review.
Understands medical terminology and standard medical procedures as they pertain to worker’s compensation, U.S. Longshoreman’s and Jones Act claims.
Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics.
Maintains a working knowledge of all computer systems currently in use.
Travels throughout States as required to handle claims inventory assigned.

Requirements

What you’ll need

One to four years of workers’ compensation lost time claim handling experience preferred.
Bachelor’s degree preferred.
Computer skills, Word, Excel and Image Right preferred.
Must have a valid driver’s license.
Strong attention to detail and strong communication skills both verbal and written.
Adaptable/flexible and self-directed with the ability to manage time, multiple priorities and other resources wisely.
Must have the ability to work effectively with other organizational team members.

Benefits

Comp & perks

Health Insurance options, Dental Insurance options and Vision Insurance
Employee Life Insurance/AD&D and Dependent Life Insurance options
Short-term & Long-term Disability
Health Savings Account with potential employer match
Flexible Medical and Dependent Care Account
Accident Insurance
Critical Illness Insurance
Employee Assistance Program
Legal/Identify Theft Insurance options
Long Term Care Insurance
Pet Insurance
401 (k) Retirement Plan with match up to 6%, plus annual bonus based on individual & company performance.
5 weeks of Paid Time Off (PTO)
11 paid holidays

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

workers' compensation claim handlingnegotiationlitigation planningmedical managementclaims evaluationbill processingfile preparationattention to detailtime management

Soft Skills

communication skillsadaptabilityself-directionteam collaborationmentoring

Certifications

Bachelor's degreevalid driver's license