Insurance Claims Representative jobs in Buffalo, NY

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Claims Services Representative 1 / Trainee 1/Trainee 2 (NY HELPS)
  • Insurance Fund, State
  • Buffalo, NY FULL_TIME
  • For Appointment to Claims Services Representative 1, SG-18:
    • Reachable on current Civil Service eligible list for this title; OR
    • One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Administrative Specialist 1, Investigator 2 (Compensation Claims), Policyholder Services Representative 1, Underwriter 1, Underwriter 1 (Disability Benefits); OR
    • A bachelor’s or higher degree AND two years of New York State workers’ compensation claims adjustor experience; OR
    • A juris doctor, master’s or higher degree in a field related to the position being filled* AND one year of New York State workers’ compensation claims adjustor experience.
    • NYSIF will determine whether a candidate’s degree is related to the duties of the position.

    For Appointment to Claims Services Representative Trainee 1:
    • Reachable on current Civil Service eligible list for this title; OR
    • One year of permanent, competitive class service in a title eligible for transfer under Section 70.1 of the Civil Service Law. Eligible titles include, but are not limited to: Investigator 1, Assistant Insurance Fund Services Representative, Program Aide; OR
    • A bachelor's or higher degree (in any area of study).
    Candidates on the current PCO eligible list are encouraged to apply.

    Please be advised that the New York State Insurance Fund does not offer sponsorship for employment visas to employees or potential employees. Candidates sponsored for employment by an organization should be aware of their sponsorship status and the relevant expiration date(s) of that sponsorship before applying to this position.
    Duties Description
    Responsibilities include, but are not limited to:
    • Oversee all aspects of workers’ compensation claims processing start-to-finish.
    • Examine, strategize, and apply strong claims judgment in accordance with NYSIF polices and Workers Compensation Law.
    • Determine compensability of claims by examining medical reports from physicians, hospitals, and medical labs; file appropriate documentation with Workers’ Compensation Board (WCB).
    • Issue timely and accurate compensatory payments and WCB award payments.
    • Investigate unaccepted claims and prepare obtained documents for Hearing.
    • Manage medical aspects of claims in accordance with NYSIF policy.
    • Negotiate Section 32 settlements to limit NYSIF liability on specific claims.
    Additional Comments

    This position may be designated 55 b/c and is subject to verification of applicant eligibility.

    NYSIF has a telecommuting program.

    This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS).

    For the duration of the NY HELPS Program, this title maybe filled via a non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the title for which they apply. At this time, agencies may recruit and hire employees by making temporary appointments. In May 2024, if a temporary NY HELPS employee is satisfactorily performing in the position, the appointment will be changed from temporary pending Civil Service Commission Action to permanent non-competitive and the official probationary period will begin.

    At a future date (within one year of permanent appointment), it is expected employees hired under NY HELPS will have their non-competitive employment status converted to competitive status, without having to compete in an examination. Employees will then be afforded with all of the same rights and privileges of competitive class employees of New York State. While serving permanently in a NY HELPS title, employees may take part in any promotion examination for which they are qualified.

    The New York State Insurance Fund (NYSIF) was established in 1914 as part of the original enactment of the New York State Workers’ Compensation Law. NYSIF's mission is to guarantee the availability of workers’ compensation insurance at the lowest possible cost to New York employers and to provide timely, appropriate indemnity and medical payments to injured workers, while maintaining a solvent fund. Since inception, NYSIF has fulfilled the dual roles for which it was created: to compete with other carriers to ensure a fair marketplace and to be a guaranteed source of coverage for employers who cannot secure coverage elsewhere.

    NYSIF is the largest workers’ compensation carrier in New York State and among the top ten largest workers’ compensation carriers in the nation, insuring approximately 131,000 policyholders, with more than $1.6 billion in annual earned premium and over $22 billion in assets. A self-supporting insurance carrier, NYSIF operates without taxpayer funding.

    In addition to workers’ compensation insurance, NYSIF provides disability benefits coverage for off-the-job injuries to more than 57,500 New York employers. In 2018, NYSIF added paid family leave as a component of its disability benefits product, providing New Yorkers with job-protected, paid time away from work to care for their families.

    NYSIF Commitment to Diversity, Equity, and Inclusion
    The New York State Insurance Fund (NYSIF) prioritizes and champions diversity, equity, and inclusion (DEI) throughout our agency. NYSIF provides equal opportunities to all employees and applicants for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability, veteran status, or any other protected category under federal, state, and local law. We believe that embracing our differences brings richness, new ideas and experiences to NYSIF, which energizes a creative and innovative work environment. We strive to foster a workplace where diverse individuals are able to participate fully in the decision-making process and have ample opportunity for advancement. We are committed to investing the necessary resources and attention to improving the engagement, retention, and promotion of the extraordinary talent we have.

    In addition to workers’ compensation insurance, NYSIF provides disability benefits coverage for off-the-job injuries to more than 56,000 New York employers. In 2018, NYSIF added paid family leave as a component of its disability benefits product, providing New Yorkers with job-protected, paid time away from work to care for their families.

    NYSIF Commitment to Diversity, Equity, and Inclusion
    The New York State Insurance Fund (NYSIF) prioritizes and champions diversity, equity, and inclusion (DEI) throughout our agency. NYSIF provides equal opportunities to all employees and applicants for employment without regard to race, religion, color, age, sex, national origin, sexual orientation, gender identity, disability, veteran status, or any other protected category under federal, state, and local law. We believe that embracing our differences brings richness, new ideas and experiences to NYSIF, which energizes a creative and innovative work environment. We strive to foster a workplace where diverse individuals are able to participate fully in the decision-making process and have ample opportunity for advancement. We are committed to investing the necessary resources and attention to improving the engagement, retention, and promotion of the extraordinary talent we have.

  • 8 Days Ago

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Assistant Insurance Fund Services Representative (NY HELPS)
  • Insurance Fund, State
  • Buffalo, NY FULL_TIME
  • For new to NYS candidates OR current NYS employees: Four years of customer service experience that required independence in both verbal and written communication responsibilities; OR an associate degr...
  • 1 Month Ago

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Fraud & Claims Operations Representative
  • B10 Wells Fargo Bank, N. A.
  • CIC Customer Information Ctr, NC FULL_TIME
  • About this role: Wells Fargo is seeking Fraud & Claims Operations Representatives in Consumer & Small Business Banking providing coverage for Consumer and Small Business Operations. Learn more about o...
  • 1 Month Ago

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Audit representative
  • Merchants Insurance Group
  • Buffalo, NY FULL_TIME
  • Description Premium Audit Service Representative Hybrid Work Schedule Buffalo, NY Merchants Insurance Group, is a leading Property and Casualty Insurer in the Northeast, and is looking for a Premium A...
  • 25 Days Ago

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Billing / customer Service Representative
  • Merchants Insurance Group
  • BUFFALO, NY FULL_TIME
  • Billing / Customer Service Representative Buffalo, New York Merchants Insurance Group, is a leading Property and Casualty Insurer in the Northeast, and is looking for an experienced Billing / Customer...
  • 24 Days Ago

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Premium Audit Service Representative
  • Merchants Mutual Insurance
  • Buffalo, NY FULL_TIME
  • Premium Audit Service Representative Hybrid Work Schedule Buffalo, NY Merchants Insurance Group, is a leading Property and Casualty Insurer in the Northeast, and is looking for a Premium Audit Service...
  • 1 Month Ago

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0 Insurance Claims Representative jobs found in Buffalo, NY area

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Remote Health Insurance Sales Representative
  • Ideal Concepts
  • Buffalo, NY
  • Job Description Job Description To be considered for this opportunity, you must have an active Health & Life insurance l...
  • 4/18/2024 12:00:00 AM

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Catastrophe Property Adjuster *MULTIPLE REMOTE LOCATIONS*
  • Erie Insurance
  • Buffalo, NY
  • Division or Field Office: Claims Division Department of Position: Catastrophe Operations Dept Work from: Home, within ER...
  • 4/18/2024 12:00:00 AM

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Insurance Claims Specialist Buffalo, NY
  • Government Employees Insurance Company
  • Buffalo, NY
  • Claims Service Specialist Buffalo, NY *In Office Position* Salary: $22.34 hourly / $45,015 annually Claim your career gr...
  • 4/18/2024 12:00:00 AM

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Insurance Claims Specialist Buffalo, NY
  • Government Employees Insurance Company
  • Tonawanda, NY
  • Claims Service Specialist Buffalo, NY *In Office Position* Salary: $22.34 hourly / $45,015 annually Claim your career gr...
  • 4/17/2024 12:00:00 AM

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Public Insurance Adjuster Buffalo, NY Office - Remote Opportunity in Region
  • Adjusters International/Basloe, Levin & Cuccaro
  • Buffalo, NY
  • * Public Insurance Adjuster Buffalo, NY Office - Remote Opportunity in Region **Public Insurance Adjuster Buffalo, NY Of...
  • 4/17/2024 12:00:00 AM

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Public Insurance Adjuster Buffalo, NY Office
  • Adjusters International/Basloe, Levin & Cuccaro
  • Buffalo, NY
  • * Public Insurance Adjuster Buffalo, NY Office **Public Insurance Adjuster Buffalo, NY Office** * Buffalo, New York **Jo...
  • 4/16/2024 12:00:00 AM

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Entry level to insurance agency owner remote (Buffalo, NY)
  • Adair Agency
  • Buffalo, NY
  • We are seeking a highly motivated individual that is ready to become licensed or who is currently licensed to join our t...
  • 4/14/2024 12:00:00 AM

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Admissions Screener
  • Weinberg Campus
  • Getzville, NY
  • DEPARTMENT: Rosa Coplon Living Center Admissions EXPERIENCE: Professional STATUS: Full Time SHIFT: Monday-Friday, Day sh...
  • 4/14/2024 12:00:00 AM

Buffalo is the second largest city in the U.S. state of New York and the largest city in Western New York. As of July 2016[update], the population was 256,902. The city is the county seat of Erie County and a major gateway for commerce and travel across the Canada–United States border, forming part of the bi-national Buffalo Niagara Region. The Buffalo area was inhabited before the 17th century by the Native American Iroquois tribe and later by French settlers. The city grew significantly in the 19th and 20th centuries as a result of immigration, the construction of the Erie Canal and rail tra...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Insurance Claims Representative jobs
$44,211 to $58,669
Buffalo, New York area prices
were up 1.5% from a year ago

Insurance Claims Representative
Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval.
September 16, 2022
Demonstrate proficiency in file audits to agreed standard of efficient claims quality.
October 17, 2022
Participates in department quality improvement, clinic safety, infection control and hazardous materials programs and activities.
December 15, 2022
Adheres to all policies and procedures.
January 04, 2023
Contact insurance companies in reference to all insurance claims.
February 13, 2023
Review and validation of requests for claim review and other claims documents.
February 16, 2023
Seeks assistance from Team Subject Matter Experts (SMEs), the Trainer and Claims Manager to ensure accuracy of adjudicating claims and to develop individual skills and grow professionally.
February 16, 2023
Documents all insurance information into eachaccount, includes patient co payments and deductible amounts (if applicable).
March 25, 2023