Job Description

Job Title: Claims Examiner-Lost Time

Duration: 3+ Months (CTH)

Location: New Haven, CT

Job Schedule- 5 days on-site

Job hours-8:30am-5:00pm EST

• 3+ years of Workers’ Compensation Lost Time Claim Examiner or Commensurate Experience (Having experience in worker’s compensation is not a requirement but a nice thing to have, as long as the skills they do have are transferable.)
• Lost Time Claim Examiner position with prior experience in workers’ compensation as a medical only examiner, or commensurate examiner experience in paralegal, short-term / long-term disability, auto personal injury protection / medical injury, general liability or as a claim technical assistant for lost time claims.
• - Requires knowledge of workers’ compensation statutes, regulations and compliance.

Duties and Responsibilities:

• - Handles all aspects of workers’ compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
• - Reviews claim and policy information to provide background for investigation.
• - Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers.
• - Evaluates the facts gathered through the investigation to determine compensability of the claim.
• - Informs insureds, claimants and attorneys of claim denials when applicable.
• - Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc.
• - Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
• - Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team
• Leader throughout the life of the claim.
• - Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
• - Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
• - Works with attorneys to manage hearings and litigation
• - Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.
• - Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
• - Files workers’ compensation forms and electronic data with states to ensure compliance with statutory regulations.
• - Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
• - Works with in-house Technical Assistants, Special Investigators, Nurse
• Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.

Technical Skills & Competencies:

• - Lost Time Claim Examiner position with prior experience in workers’ compensation as a medical only examiner, or commensurate examiner experience in paralegal, short-term / long-term disability, auto personal injury protection / medical injury, general liability or as a claim technical assistant for lost time claims.
• - Requires knowledge of workers’ compensation statutes, regulations and compliance.
• - Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues.
• - Exceptional customer service and focus.
• - Ability to openly collaborate with leadership and peers to accomplish goals.
• - Demonstrates a commitment to a career in claims.
• - Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines.
• - Use analytical skills to find mutually beneficial solutions to claim and customer issues.
• - Ability to prepare and make exceptional presentations to internal and external customers.
• - Conscientious about the quality and professionalism of work product and relationships with co-workers and clients.
• - Willing to take ownership and tackle obstacles to meet Client's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
• - Superior verbal and written communication skills.

Experience, Education & Requirements:

• - Experience working in a customer focused, fast-paced, fluid environment
• - Experience utilizing strong communication and telephonic skills
• - Prior experience requiring a high level of organization, follow-up and accountability
• - Prior workers’ compensation claim handling experience is a plus but not required
• - Familiarity with claim handling (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability) is a plus but not required
• - Prior insurance, legal or corporate business experience is a plus but not required
• - AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
• - Proficiency with Microsoft Office Products
• - Knowledge of medical terminology is a plus but not required
• - Knowledge of bill processing is a plus but not required
• - Claim Adjuster licenses in Connecticut, New Hampshire, Rhode Island and Vermont, are necessary; however, they are not required at the time of posting for the position. - If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure

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