Job Title: Senior Case Analyst
Type of Company: My company administers workers' compensation insurance claims for cities and towns across New York State.
Education: BA, English, SUNY-Albany
Previous Experience: I worked in an administrative capacity for several insurance companies both in the claims department and loss control department for about 7 years, before moving up into a beginner claims adjuster position (2 years), then a regular claims adjuster position (2 years), and finally as a senior claims adjuster.
Job Tasks: My primary job as a claims adjuster is to evaluate new workers' compensation claims for coverage and compensability, pay claims fairly and promptly, and bring claims to a prompt resolution. If an employee is injured on the job, it is his responsibility to report it to his employer in a timely manner, and it's the employer's responsibility to report it to our company in a timely manner.
When we receive the first notice of loss, it is assigned to a claims adjuster, who reviews the claim to see if it is covered. Contact is made with the injured worker and employer to explain coverage and benefits. If the injured worker is unable to work, workers' compensation pays a portion of their wages while they are disabled. When medical bills are received, they are reviewed to ensure that they are related to the covered claim, and they are adjusted according to a fee schedule and paid in a timely manner. When the injured worker returns to work, and when treatment concludes, the claim can be closed.
There are times when a claim must go before the Workers' Compensation Board, which is the governing body overseeing all workers' compensation insurance companies, and the claim is heard before a judge. This is an extremely simplified and basic description of the job; there are many rules and laws and regulations with workers' compensation insurance, and there are so many different claims scenarios to evaluate for coverage.
Best and Worst Parts of the Job: The best (and worst!) part of the job is that New York state has the most complicated, at times frustrating, and detailed workers' compensation system of any state in America! What this means is, you can't just walk into this job and "get it" in two weeks. It takes a long time to learn the system, and you really use your brain every single day. It is fascinating, never boring, and the pay is very good. Another frustrating thing is that the average person knows very little about workers' compensation, and has such a bad view of insurance companies in general, that when a claim isn't covered they usually get angry with the adjuster. It is important to remember that the adjuster doesn't make the rules and regulations, but they do have to follow them and try to explain benefits to the injured worker to the best of their ability. Luckily, the good days outweigh the bad.
1. With a college degree, you can often become a claims adjuster at a bigger company with little or no experience. They will train you.
2. Get your adjuster's license and keep it current.
3. Take the Associate in Claims' courses for an AIC certification.
4. Learn as much as you can by doing. With workers' compensation, you can't learn everything from a book. I have been adjusting claims for 13 years, and I'm still learning.
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