Workers' Compensation Complex Claims Adjuster (NY)

In this role, you’ll manage a caseload of complex, lost‑time and litigated NY claims from start to finish, ensuring accuracy, timeliness, and strategic decision‑making. You will:

• Handle complex NY loss‑time workers’ compensation claims, including litigated matters and high‑exposure files.
• Determine compensability and coverage for claims under New York Workers’ Compensation Law and other applicable jurisdictions.
• Drive settlement strategy, including negotiation and finalization of agreements under management review.
• Gather, evaluate, and interpret medical and factual evidence to support defensible claim outcomes.
• Coordinate and lead outside investigations, including IMEs, surveillance, and specialized field work.
• Manage and direct outside counsel, ensuring litigation progresses efficiently and within authority.
• Communicate frequently with injured workers, attorneys, investigators, medical providers, insureds, agents, and internal partners.
• Execute timely and accurate claims handling, including documentation, reserving, payment processing, and compliance reporting.

We’re looking for a seasoned professional who understands the nuances, pace, and legal demands of New York Workers’ Compensation claims. The ideal candidate has:

• 3+ years of New York loss‑time workers’ compensation experience, including litigated claims (required).
• Experience handling NY Employer’s Liability claims (strong plus).
• Ability to manage claims across multiple jurisdictions, with willingness to learn additional states.
• Strong negotiation, conflict resolution, and problem‑solving skills.
• Excellent organization and time‑management, with the ability to handle a fast‑moving caseload.
• Effective written and verbal communication skills, including file documentation and attorney interactions.
• A positive, solutions‑oriented approach and the ability to contribute to a high‑performing team.
• Bachelor’s degree preferred; equivalent experience considered.
• Active NY Adjuster License a strong plus.