Claims Manager, No Fault

Responsibilities

• Direct and oversee no-fault claims handling, coverage analysis, benefit determinations, and settlement decisions to ensure accurate, timely, and legally compliant claim resolution
• Supervise a team of claims examiners and administrative staff
• Provide legal and technical guidance to claims staff on liability evaluation, benefits eligibility, litigation exposure, and negotiation strategies for no-fault claims
• Review no-fault claims submitted by claimants, medical providers, and hospitals to ensure completeness and compliance with applicable regulations and internal standards
• Interpret and apply applicable no-fault statutes, regulations, policy language, and case law, including New York State Regulation 68, to complex claim files and coverage disputes
• Process approved no-fault claims for payment using the computerized no-fault system and related claim platforms in accordance with established controls
• Prepare no-fault claim cases for arbitration proceedings, including file review, documentation, and coordination under established legal and procedural guidelines
• Respond to telephone and written inquiries from medical service providers, hospitals, and claimants regarding claim status, required documentation, and benefit determinations
• Develop, implement, and maintain guidelines, procedures, and quality controls for no-fault claims adjudication, documentation standards, and file review practices

Requirements

• Required Knowledge/Skills/Abilities:
  • Insurance claims management
  • No-fault insurance
  • Legal research
  • Regulatory compliance
  • Negotiation
  • Risk analysis
  • People management
  • Data analysis
  • Process improvement
  • Stakeholder management
• Required Education And Experience:
  • Bachelor’s Degree in Arts/Sciences (BA/BS) from an accredited college, including or supplemented by 6 credits in mathematics, statistics, accounting, and/or actuarial science, and two years of full-time experience involving the use of mathematical, statistical, actuarial, or accounting computations
  • Associate’s Degree (AA) with coursework in mathematics, statistics, accounting, actuarial science, or related quantitative field, and five to seven years of experience as described in "1" above
  • High school Diploma or General Education Degree (GED) or equivalent with substantial experience in benefit plan or claims administration, and eight years of full-time experience as described in "1" above
  • Minimum 4 years of experience in no-fault or similar insurance claims management, including responsibility for complex claim files and payment determinations
  • Minimum 2 years of experience implementing provisions of retirement, workers’ compensation, or medical benefit plans involving mathematical, statistical, actuarial, or accounting computations
  • Minimum 2 years of experience managing a team that interfaces with internal departments and the general public

Qualifications

May need to work outside of normal work hours (i.e., evenings and weekends)

Travel may be required to other MTA locations or other external sites.

Benefits

According 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”).

Skills

Equal Employment Opportunity
The MTA is an Equal Opportunity Employer, including those concerning veteran status and individuals with disabilities. The MTA encourages qualified applicants from diverse backgrounds, experiences, and abilities, including military service members, to apply.