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Job Title: Sr. Worker's Comp Specialist
Company: NorthEast Provider Solutions Inc.
City/State: Valhalla, NY
Category: Professional/Non-Clinical
Department: Leave Management- WMC Health
Union: No
Position: Full Time
Hours: M-F 9-5
Shift: Day
Req #: 49656
Posted Date: Aug 27, 2026
Hiring Range: $95,520 -$120,082
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External Applicant link Internal Applicant link
Job Details:
Job Summary:
Under the direction of the Sr. Director of Leave Management, the Workers' Compensation Specialist will utilize knowledge of Workers' Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position the Specialist will manage and resolve Workers' Compensation claims in a timely manner in accordance with legal statues, policy provisions, and organizational guidelines. In addition, the Workers' Compensation Specialist will manage a caseload of claims from inception to closing or settlement.
Responsibilities:
- Serves as the subject matter expert for workers' compensations.
- Acts as the primary point of contact for each injured employee for the duration of their workers' compensation claim; acts as liaison between injured employee and workers' compensation adjuster; and follows up with injured employee as needed to ensure claim is progressing properly.
- Investigates claims to determine an injured worker's entitlement to Workers' Compensation benefits; administers indemnity and medical benefits for valid Workers' Compensation claims.
- Provide advice and counsel regarding claims management, claim compensability and/or settlement strategies with Medline, TPAs, nurse case managers and defense attorneys.
- Responsible for receiving, organizing, and analyzing all files and documents related to the injured worker and the injury in order to make an effective and accurate determination concerning the claim.
- Performs interview with the injured employee to obtain a detailed description of how the injury occurred.
- Performs interview with the employee's supervisor to verify the description of the incident and what could have been done to prevent the incident.
- Conducts investigations of alleged fraudulent activity of all leave cases and workers' compensation.
- Contacts the employee immediately following the initial medical treatment for diagnosis, prognosis, and expected period of disability, if any.
- Analyzes and processes workers' compensation claims by investigating and gathering information to determine compensability and exposure.
- Ensure accurate and timely reporting of all workers' compensation claims by all employees and management to the appropriate vendor or state agency.
- Reviews and maintains personal diary on claims.
- Maintains weekly telephone contact with the employee while off work and treating.
- Investigates, evaluates and strategizes on resolution of non-litigated matters.
- Compiles and reviews claim data; identifies risk exposures through evaluation of loss statistics and trends.
- Collaborates closely with the Workers' Compensation Manager in developing business unit risk management strategies, placement, and management of Workers' Compensation program for the Network
- Provide insightful and comprehensive risk management consulting services to business areas including return-to-work timelines, new acquisition compliance, lost time tracking, and safety reviews of work environments.
- Keeps Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Manager for direction.
- Reports claims to the excess carrier when applicable.
- Coordinates return to work (RTW) and sets target dates.
- Documents files in the Leave Management systems.
- Effective and timely coordination of communication with supervisors/managers, claimants and other appropriate parties throughout the claim process.
- Perform other duties as assigned or required.
Qualifications/Requirements:
Experience:
Minimum of 5 years' experience handling New York State workers' compensation claims.
Education:
Associates Degree, required. Bachelor's Degree, preferred.
Licenses / Certifications:
Other:
Special Requirements:
- Proficiency in Microsoft Office applications and familiarity with necessary tools such as spreadsheets.
- Strong organizational skills and demonstrated ability to prioritize work.
- Good time management skills to investigate and give a report on claims within a given time frame.
- Ability to lead and work effectively and collaboratively within team settings and build partnerships both internal and external.
- Effective deliberation and negotiating skills resulting in successful outcomes.
- Analytical thinking and particular attention to detail which enables to strategically handle investigations and tactically tackle issues.
- Adequate knowledge of relevant regulations and policies and procedures.
- Excellent verbal and written communication skills to effectively communicate with co-workers, supervisors and managers.
About Us:
NorthEast Provider Solutions Inc.
Benefits:
We offer a comprehensive compensation and benefits package that includes:
- Health Insurance
- Dental
- Vision
- Retirement Savings Plan
- Flexible Savings Account
- Paid Time Off
- Holidays
- Tuition Reimbursement
Apply Now
External Applicant link Internal Applicant link