Our client, a leading insurance company, is hiring a Claims Examiner-Lost Time on a contract basis
Job ID #: 83867
Work Location: New Haven, CT/ONSITE
Summary:
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 workers compensation is not a requirement but a nice thing to have, as long as the skills they do have are transferable.)
Duties and Responsibilities:
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Handles all aspects of workers compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
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Reviews claim and policy information to provide background for investigation.
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Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers.
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Evaluates the facts gathered through the investigation to determine compensability of the claim.
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Informs insureds, claimants and attorneys of claim denials when applicable.
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Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc.
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Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
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Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to Team
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Leader throughout the life of the claim.
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Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
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Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.
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Works with attorneys to manage hearings and litigation
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Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.
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Complies with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
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Files workers compensation forms and electronic data with states to ensure compliance with statutory regulations.
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Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.
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Works with in-house Technical Assistants, Special Investigators, Nurse
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Consultants, Telephonic Case Managers as well as Team Supervisors to exceed customer’s expectations for exceptional claims handling service.
Technical Skills & Competencies:
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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.
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Requires knowledge of workers compensation statutes, regulations and compliance.
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Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues.
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Exceptional customer service and focus.
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Ability to openly collaborate with leadership and peers to accomplish goals.
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Demonstrates a commitment to a career in claims.
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Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines.
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Use analytical skills to find mutually beneficial solutions to claim and customer issues.
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Ability to prepare and make exceptional presentations to internal and external customers.
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Conscientious about the quality and professionalism of work product and relationships with co-workers and clients.
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Willing to take ownership and tackle obstacles to meet client’s quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
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Superior verbal and written communication skills.
Experience, Education & Requirements:
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Experience working in a customer focused, fast-paced, fluid environment
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Experience utilizing strong communication and telephonic skills
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Prior experience requiring a high level of organization, follow-up and accountability
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Prior workers compensation claim handling experience is a plus but not required
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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
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Prior insurance, legal or corporate business experience is a plus but not required
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AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
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Proficiency with Microsoft Office Products
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Knowledge of medical terminology is a plus but not required
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Knowledge of bill processing is a plus but not required
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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
Pay Range: $39-40