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 Adjuster/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.
This is a 100% fully remote position.
Essential Functions
1. Claims Adjusting Work (NYTIC / Emerald):
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Perform intake and coverage verification via WCB employer coverage search
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Initiate three-point contact (employer/clamant/provider) within 24 hours
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Conduct compensability analysis and develop action plans
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Ensure timely filings: employer first report, EDI FROI/SROI via Emerald, PH-16.2, and C-240 wage statement
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Calculate AWW and benefit rates; set and review reserves at key milestones
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Monitor treatment against NY Medical Treatment Guidelines; manage MG-2 variance requests and C-8.1 objections
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Route medical bills to bill review and ensure fee schedule compliance
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Prepare for hearings and maintain eCase updates
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Evaluate resolution paths (SLU, LWEC, Section 32); manage subrogation and third-party notices
2. Licensing & Compliance (Jones Jones):
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Collaborate with the Compliance team on licensing forms and regulatory filings
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Review TPA scorecards and ensure compliance with WCB standards
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Track and invoice licensing fees and renewals
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Support examiner training and respond to licensing-related inquiries
3. ADR (MRM):
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Manage intake, eligibility, and notices under the collectively bargained ADR program
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Coordinate and schedule mediations
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Draft case summaries and settlement proposals
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Ensure adherence to Medical Network protocols and document variances
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Prepare and route settlement paperwork, including Section 32 agreements
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Maintain dashboards of ADR cycle times and outcomes for annual reporting
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Obtain loss runs from wrap-up sponsors
4. MMG
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Evaluate Independent Medical Examination (IME) reports for accuracy and compliance
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Assist with administrative tasks such as schedule coordination and provider panel management
Competencies
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Excellent and professional verbal and written communication skills
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Strong understanding of workers’ compensation best practices
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Exceptional organizational skills and attention to detail
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Excellent time management skills with a proven ability to meet deadlines
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Strong analytical and problem-solving skills
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Ability to perform well in a fast-paced, dynamic environment
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Ability to maintain confidentiality and exercise discretion and sound judgment
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Proficient with Microsoft Office Suite or related software
Qualifications
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Bachelor’s degree in business administration or related field
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Active Independent Adjuster License (New York State required)
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3 - 5 years of claims management experience
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Must have experience with filing FROIs and SROIs
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Must have EDI filing experience
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.
