Workers' Compensation Complex Claims Adjuster (NY)

Overview

Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett’s Berkshire Hathaway group – one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.

Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company’s success is grounded in our core values:  accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!

Benefits:

We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You’ll be surprised by all we have to offer!

• Competitive compensation
• Healthcare benefits package that begins on first day of employment
• 401K retirement plan with company match
• Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
• Up to 6 weeks of parental and bonding leave
• Hybrid work schedule (3 days in the office, 2 days from home)
• Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
• Tuition reimbursement after 6 months of employment
• Numerous opportunities for continued training and career advancement
• And much more!

Responsibilities

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.

Qualifications

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:

• 5 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.