Metropolitan Transportation Authority Careers

Description

POSITION SUMMARY 

The Claims Examiner evaluates, adjudicates, and resolves no-fault insurance claims in accordance with legal, regulatory, and policy requirements, ensuring accurate coverage determinations and timely benefit payments. No Fault Claims Examiner is responsible for analyzing claim documentation and medical records to determine coverage and compensability, applying relevant statutes and policy provisions to make liability and benefit decisions, and communicating determinations and required actions to involved parties in a clear and compliant manner.

RESPONSIBILITIES 

• Analyze no-fault insurance claims, supporting documentation, and medical records to determine coverage, compensability, and benefit eligibility in accordance with applicable laws, regulations, and policy provisions.
• Apply legal, regulatory, and policy requirements to evaluate liability, calculate benefits, set reserves, and make adjudication decisions on no-fault claims, documenting rationale and outcomes in claim systems.
• Communicate clearly, both verbally and in written reports, claim determinations, required actions, and rationale to claimants, legal representatives, medical providers, and internal stakeholders in a clear, neutral, and compliant manner.
• Identify, investigate, and resolve potential fraud indicators or discrepancies by reviewing records, requesting additional information, and coordinating with internal or external investigative resources.
• Monitor and manage assigned claim inventory to meet timeliness, quality, and regulatory standards, prioritizing activities based on risk, complexity, and statutory deadlines.
• Maintain accurate and complete electronic claim files, including notes, documentation, and correspondence, to support audit, litigation, and regulatory review requirements.
• Collaborate with legal, medical, and operational resources to address complex coverage issues, disputes, and litigation, providing claim file analysis and factual summaries as needed.

EDUCATION AND EXPERIENCE  

Associate Staff Analyst  

1. A master’s degree from an accredited college or university in economics, finance, accounting, business or public administration, human resources management, management science, operations research, organizational behavior, industrial psychology, statistics, personnel administration, labor relations, psychology, sociology, human resources development, political science, urban studies, or a Juris Doctor degree from an accredited law school, and one year of satisfactory full-time professional experience in one or a combination of the following: working with the budget of a large public or private concern in budget administration, accounting, economic or financial administration, or fiscal or economic research; in management or methods analysis, operations research, organizational research or program evaluation; in personnel or public administration, recruitment, position classification, personnel relations, labor relations, employee benefits, staff development, employment program planning/administration, labor market research, economic planning, social services program planning/evaluation, or fiscal management, or in a related area; or 

2. A baccalaureate degree from an accredited college or university and three years of satisfactory full-time professional experience in the areas described in "1" above; or 

3. An associate degree or completion of 60 semester credits from an accredited college and five years of satisfactory full-time professional experience as described in “1” above; or 

4. A four-year high school diploma or its educational equivalent approved by a State’s department of education or a recognized accrediting organization and seven years of satisfactory full-time professional experience as described in “1” above; or 

5. A combination of education and/or experience equivalent to “1”, “2”, “3”, or “4” above. College education may be substituted for professional experience at the rate of 30 semester credits from an accredited college for one year of experience. However, all candidates must have a high school diploma and at least one year of experience as described in “1” above. 

Staff Analyst I & Staff Analyst II
1. A master’s degree from an accredited college or university in economics, finance, accounting, business or public administration, human resources management, management science, operations research, organizational behavior, industrial psychology, statistics, personnel administration, labor relations, psychology, sociology, human resources development, political science, or urban studies, or a Juris Doctor degree from an accredited law school; or

2. A baccalaureate degree from an accredited college or university and two years of satisfactory full-time professional experience in one or a combination of the following areas: working with the budget of a large public or private concern in budget administration, accounting, economic or financial administration, or fiscal or economic research; in management or methods analysis, operations research, organizational research or program evaluation; in personnel or public administration, recruitment, position classification, personnel relations, labor relations, employee benefits, staff development, employment program planning/administration, labor market research, economic planning, social services program planning/evaluation, or fiscal management; or in a related area; or

3. An associate degree or completion of 60 semester credits from an accredited college or university and four years of satisfactory full-time professional experience as described in "2" above: or

4. A four-year high school diploma or its educational equivalent and six years of satisfactory full-time professional experience as described in "2" above; or

5. A combination of education and/or experience equivalent to "1", "2", "3", or "4" above. College education may be substituted for professional experience at the rate of 30 semester credits from an accredited college or university for one year of experience. However, all candidates must have a high school diploma. 

DESIRED SKILLS  

• Claims adjudication and claims caseload management
• Demonstrated proficiency with Microsoft Office suite and claims processing systems
• Insurance coverage analysis
• Legal and regulatory compliance
• Medical record review
• Fraud detection and prevention
• Ability to negotiate and engage with internal and external stakeholders
• Strong presentation skills
• Strong communication skills both verbal and written

Selection Method:   

Based on evaluation of education, skills, experience, and interview.   

Other Information:
Pursuant to the New York State Public Officers Law & the MTA Code of Ethics, all employees who hold a policymaking position must file an Annual Statement of Financial Disclosure (FDS) with the NYS Commission on Ethics and Lobbying in Government (the “Commission”).   

Equal Employment Opportunity:   

MTA and its subsidiary and affiliated agencies are Equal Opportunity Employers, including with respect to veteran status and individuals with disabilities.   

The MTA encourages qualified applicants from diverse backgrounds, experiences, and abilities, including military service members, to apply.