Claims Examiner

New Haven, Connecticut

Comptech Associates
Job Expired - Click here to search for similar jobs

Job Title: Claims Examiner-Lost Time

Duration: 3 months (CTH-Contract to Hire)

Location: Grand Rapids, MI

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.)

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

Date Posted: 16 May 2025
Job Expired - Click here to search for similar jobs