Claim Specialist II - 1st Party No Fault Claims

All applicants must be current City of New York employees serving in a permanent (not provisional) Civil Service title of Claim Specialist. To be considered for this position, PLEASE CLEARLY INDICATE YOUR CURRENT PERMANENT CIVIL SERVICE TITLE on your resume and cover letter.

Qualified persons with a disability who are eligible for the 55-a Program are also eligible to apply. Please indicate at the top of your resume and cover letter that you would like to be considered for the position through the 55-a Program.

The New York City Comptroller’s Office works to promote the financial health, integrity, and effectiveness of New York City government, in order to strengthen trust, secure a thriving future for all New Yorkers, and build a more just, equitable, and resilient city. Led by an independently elected citywide official, the comptroller’s office provides checks and balances needed to hold City government accountable for budgeting wisely, investing responsibly, operating efficiently, acting fairly, living up to its obligations and promises, and paying attention to the long-term challenges we face together.

Authorized by the New York City Charter, the Comptroller, through the Bureau of Law and Adjustment (BLA), negotiates and approves all monetary settlement of claims and lawsuits involving the City of New York. BLA investigates and, when in the best interest of the city, settles pre-litigation claims for and against the City of New York. In resolving claims before litigation is commenced, BLA protects the fiscal interest of the City while ensuring that pre-litigation claims are resolved in a fair and just manner, and in accordance with applicable laws. BLA furthers this goal in its review, evaluation, and authorization of requests to settle litigated cases involving the City and through diligent administration of disputes arising out of City contracts. BLA manages City risk by holding agencies accountable, rooting out fraud, and identifying trends, as well as, coordinating with the Law Department and other City agencies on issues that impact the public fiscal and public safety.

The primary responsible of this position is the adjusting of 1st Party No-Fault claims. This role will report directly to the Assistant Division Chief of 1st Party No-Fault Unit. Duties and responsibilities of the position include, but are not limited to the following:

1) Set up No-fault claim files which includes issuing and processing NF2 application, confirming the City’s involvement on the claim submission and, issuing verification letters to claimants and medical providers;
2) Review and disallow claims for improper service or for exceeding the $50,000 threshold under New York State No Fault Law;
3) Review all new claims for data accuracy and coverage per Regulation 68 and make necessary updates in the OAISIS claim file;
4) Request agency reports, after checking library, CRASH report and related claims are made;
5) Send delay or verification letter to medical providers as per the required rules prior to coverage being confirmed, and within the mandated 30-day timeframe under Regulation 68;
6) Manage individual No-fault files and review investigation reports, medical reports, bills and ledgers, agency reports, and all other supporting documentation to determine eligibility of No-fault benefits;
7) Authorize and process payments of medical bills using fee schedule, lost wages, and additional reimbursements on 1st-Party No-fault claims;
8) Process Lost Wages and additional expenses on 1st Party No Fault claims;
9) Respond to New York State Department of Financial Services correspondence;
10) Review medical providers and law firms to ensure all entities are in Financial Management System which includes confirming an accurate and most recent W9 form is provided;
11) Maintain accurate and complete claim files, prepare claim abstracts detailing the relevant information about the investigation and evaluation of liability and damages, document any events or conversations in claim notes, and upload documents upon receipt;
12) Use available databases, media outlets, and other available sources to gather information relevant to the investigation of the claim;
13) Investigate, identify, and report fraudulent claims, utilize statistical data to identify claims that pose potential risks, and provide risk management recommendations to the Division Chief;
14) Communicate effectively and professionally with other Comptroller staff, City agency employees, pro se claimants, and attorneys when investigating a claim or negotiating a settlement;
15) Performs related assignments and special projects as required.

Qualification/Requirements:

All applicants must be current City of New York employees serving in a permanent (not provisional) Civil Service title of Claim Specialist. To be considered for this position, PLEASE CLEARLY INDICATE YOUR CURRENT PERMANENT CIVIL SERVICE TITLE on your resume and cover letter.

Qualified persons with a disability who are eligible for the 55-a Program are also eligible to apply. Please indicate at the top of your resume and cover letter that you would like to be considered for the position through the 55-a Program.

CLAIM SPECIALIST - 30726

1. A baccalaureate degree from an accredited college or university; or

2. An associate degree or 60 semester credits from an accredited college or university and two years of full-time satisfactory experience investigating and/or settling claims for personal injury or property damage or loss; or

3. A four-year high school diploma or its educational equivalent approved by a State's Department of Education or a recognized accrediting organization and four years of full-time satisfactory
experience investigating and/or settling claims for personal injury or property damage or loss; or

4. A satisfactory combination of education and/or experience that is equivalent to “1”, “2” or “3” above.

College education may be substituted for experience as described in “2” or “3” above on the basis that 30 semester credits from an accredited college or university may be substituted for each year of
required experience. However, all candidates must have a four-year high school diploma or its
educational equivalent.

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.