Claims ExaminerJones Jones LLC • New York, NY, US
Claims Examiner
Jones Jones LLC • New York, NY, US
[job_card.30_days_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]Collaborate with the Compliance team on licensing forms and regulatory filings Review TPA scorecards and ensure compliance with WCB standards Track and invoice licensing fees and renewals Support examiner training and respond to licensing-related inquiries Manage intake, eligibility, and notices under the collectively bargained ADR program Coordinate and schedule mediations Draft case summaries and settlement proposals Ensure adherence to Medical Network protocols and document variances Prepare and route settlement paperwork, including Section 32 agreements Maintain dashboards of ADR cycle times and outcomes for annual reporting Obtain loss runs from wrap-up sponsors Evaluate Independent Medical Examination (IME) reports for accuracy and compliance Assist with administrative tasks such as schedule coordination and provider panel management Excellent and professional verbal and written communication skills Strong understanding of workers’ compensation best practices Exceptional organizational skills and attention to detail Excellent time management skills with a proven ability to meet deadlines Strong analytical and problem-solving skills Ability to perform well in a fast-paced, dynamic environment Ability to maintain confidentiality and exercise discretion and sound judgment Proficient with Microsoft Office Suite or related software Bachelor’s degree in business administration or related field Active Independent Adjuster License (required) 2- 5 years of claims management experience
Job Description
Job Description
Jones Jones LLC is a trusted leader in workers’ compensation defense, claims management, and regulatory compliance. With decades of industry experience, we proudly serve clients through our affiliated entities - NYTIC, Emerald, Mediation Resolution Management, and Medical Management Group - offering innovative solutions, collaborative teamwork, and unwavering professionalism. Our firm values growth, integrity, and excellence across every level of our organization.
We are seeking an experienced Claims Examiner who is interested in growing and expanding their expertise across multiple entities, including NYTIC, Emerald, Mediation Resolution Management and Medical Management Group. This unique cross-functional role offers exposure to complex claims, compliance, and ADR operation. This role is perfect for a skilled examiner seeking to broaden scope, strengthen leadership, and grow within a premier workers’ compensation firm.
The Firm is located at 5 Hanover Square, New York, NY and this is a hybrid position.
Essential Functions
1. Claims Adjusting Work (NYTIC / Emerald) :
- Perform intake and coverage verification via WCB employer coverage search
- Initiate three-point contact (employer / clamant / provider) within 24 hours
- Conduct compensability analysis and develop action plans
- Ensure timely filings : employer first report, EDI FROI / SROI via Emerald, PH-16.2, and C-240 wage statement
- Calculate AWW and benefit rates; set and review reserves at key milestones
- Monitor treatment against NY Medical Treatment Guidelines; manage MG-2 variance requests and C-8.1 objections
- Route medical bills to bill review and ensure fee schedule compliance
- Prepare for hearings and maintain eCase updates
- Evaluate resolution paths (SLU, LWEC, Section 32); manage subrogation and third-party notices
2. Licensing & Compliance (Jones Jones) :
3. ADR (MRM) :
4. MMG
Competencies
Qualifications
Apply today to join a firm with over a century of success and a future focused on innovation. Jones Jones LLC is an equal employment opportunity employer.
[job_alerts.create_a_job]
Examiner • New York, NY, US
[internal_linking.similar_jobs]
Senior Property Desk Examiner (remote) Company Overview : .Raphael & Associates is a third-party claims administrator and independent claims adjusting company internationally recognized for excep...[show_more]
Overview : Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty / multi-site healthcare organizations in the U.
Perform claims resolution or medical billing and ap...[show_more]
The Claim Administrator (CA) is responsible for the timely processing and enrollment of clients in the World Trade Center Health Program (WTC HP).
The CA ensures all claims are accurately recorded i...[show_more]
Salary : $40,000-$60,000 annual.We are seeking a highly skilled and detail-oriented Claims Specialist with expertise in handling No-Fault, Worker's Compensation and all other medical insurance c...[show_more]
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 c...[show_more]
Location : Englewood Cliffs, NJ.NO C2C due to client restrictions • •.Claims Management - 2+ years of hands-on claims management experience.
Excellent written / oral communication and customer care skill...[show_more]
Schaumburg, United States; Houston, United States; Long Beach, United States; Miami Gardens, United States; Miami, United States.
Mt.Pleasant, United States; New York, United States;.Munich Re Spec...[show_more]
A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding s...[show_more]
The job responsibilities for this position will include the following : .Manage first-and third-party cyber claims.Timely and accurately analyze and address coverage issues under cyber policies;.Cond...[show_more] The Claim Administrator (CA) is responsible for the timely processing and management of clients’ Victim Compensation Fund (VCF) claims.
The CA ensures all claims are accurately recorded in int...[show_more] 
Mercor is collaborating with a top-tier AI research group to model real-world claims workflows for property and casualty insurance.
We are seeking experienced independent contractors—particula...[show_more]
A strategic and trusted insurance partner, Berkshire Hathaway Specialty Insurance (BHSI), provides a broad range of commercial property, casualty and specialty insurance coverages and outstanding s...[show_more]
Location : Englewood Cliffs, NJ.NO C2C due to client restrictions.Claims Management - 2+ years of hands-on claims management experience.
Excellent written / oral communication and customer care skills....[show_more]
Worker’s compensation insurance is a headache.We make it simple, smooth, and stress free.Join us in redefining workers’ comp.
The Workers’ Compensation Claims Examiner is responsib...[show_more] Liability Desk Examiner (remote) Company Overview : .Raphael & Associates is a third-party claims administrator and independent claims adjusting company internationally recognized for exceptional...[show_more] 
At AIG, we are reimagining the way we help customers to manage risk.Join us as a Complex Claims Director to play your part in that transformation.
It's an opportunity to grow your skills and experie...[show_more]
PRN Healthcare is seeking a travel nurse RN Oncology for a travel nursing job in Neptune City, New Jersey.Job Description & Requirements.
PRN Healthcare Job ID #1469610.Pay package is based on 1...[show_more]
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 c...[show_more]
Senior Property Claims Examiner (Remote)
Raphael and Associates • Rutherford, NJ, US
[filters.remote]
[job_card.full_time]
[filters_job_card.quick_apply]
[last_updated.last_updated_30]
Claims Resolution Specialist
Caduceus Inc • Jersey City, NJ, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Claim Administrator I
Barasch & McGarry • Manhattan, NY, US
[job_card.full_time]
[filters_job_card.quick_apply]
[last_updated.last_updated_30]
Claims Specialist
Assist Ambulance • New York, NY, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Claims Examiner - Liability | Litigation, General Liability and Auto Preferred | NY Licensing Required - Remote
Atlanta Staffing • New York, NY, US
[filters.remote]
[job_card.full_time]
[last_updated.last_updated_variable_hours] • [promoted] • [new]
Claims Specialist 3 16476 (Englewood Cliffs)
Transcend Solutions • Englewood Cliffs, NJ, United States
[job_card.full_time]
[last_updated.last_updated_variable_hours] • [promoted] • [new]
MRSGM NA Claims Resolution Specialist, Cyber
Munich RE • New York, NY, United States
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Complex Claims Director, A&E
Berkshire Hathaway Specialty Insurance • New York, NY, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Senior Claim Examiner
Chubb • Jersey City, NJ, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Claim Administrator II
Barasch & McGarry • Manhattan, NY, US
[job_card.full_time]
[filters_job_card.quick_apply]
[last_updated.last_updated_30]
Claims Adjusters, Examiners, and Investigators
Mercor • New York, NY, US
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Senior Claims Examiner, Programs - Property and Casualty
Berkshire Hathaway Specialty Insurance • New York, NY, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Claims Specialist 3 - 16476
Transcend Solutions • Englewood Cliffs, NJ, US
[job_card.full_time]
[last_updated.last_updated_variable_hours] • [promoted] • [new]
NY LT Wokers Compensation Claims Examiner
Highview National Insurance Company • Spring Valley, NY, US
[job_card.full_time]
[last_updated.last_updated_30] • [promoted]
Liability Claims Examiner (remote)
Raphael and Associates • Rutherford, NJ, US
[filters.remote]
[job_card.full_time]
[filters_job_card.quick_apply]
[last_updated.last_updated_30]
Complex Claims Director, Excess
New Jersey Staffing • Jersey City, NJ, US
[job_card.full_time]
[last_updated.last_updated_1_day] • [promoted]
Travel Inpatient Adult Oncology RN (Leukemia / Lymphoma)
PRN Healthcare • Neptune City, NJ, US
[job_card.full_time]
[last_updated.last_updated_variable_days] • [promoted]
Claims Examiner - Liability | Litigation, General Liability and Auto Preferred | NY Licensing Required - Remote
Chicago Staffing • New York, NY, US
[filters.remote]
[job_card.full_time]
[last_updated.last_updated_variable_hours] • [promoted] • [new]