Claims Examiner

Comptech Associates; New Haven (CT); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading claims management firm is seeking a Claims Examiner-Lost Time in New Haven, CT. The ideal candidate will have over 3 years of experience in workers’ compensation claims and exceptional analytical and customer service skills. Responsibilities include managing claims from initiation to closure, conducting investigations, and ensuring compliance with regulations. This role requires excellent communication, time management, and collaboration abilities, along with proficiency in Microsoft Office products.

Qualifications

• 3+ years of experience in Workers’ Compensation Lost Time Claim handling.
• Experience in a customer-focused environment.
• Ability to prepare and make presentations.

Responsibilities

• Handles all aspects of workers’ compensation lost time claims from set-up to closure.
• Conducts ongoing investigations and evaluates facts.
• Demonstrates commitment to career in claims.

Skills

Customer service focus

Analytical skills

Time-management

Communication skills

Education

AIC, RMA, or CPCU completed coursework

Tools

Microsoft Office Products

Job description

Job Title: Claims Examiner-Lost Time

Location: 555 Long Wharf Drive, New Haven, CT. 06511

Duration: 3 months

Job Schedule: 5 days on-site

Interview Process: 1 round of interview - Virtual

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 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.
• 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.
• 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 case 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 and Team Supervisors to exceed customer's expectations for exceptional claims handling service.
• 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 adjuster’s license and possibly additional state licensure.