Lost Time Claims Examiner

Comptech Associates; New Haven (CT); On-site; USD 55,000 - 75,000; Full time

Job summary

A leading claims management firm in New Haven, CT is seeking a Claims Examiner for lost time claims. The role involves managing all aspects of workers’ compensation claims, conducting investigations, and ensuring compliance with regulations. Ideal candidates will have prior experience in workers' compensation and demonstrate exceptional customer service and communication skills. This contract position is an excellent opportunity for those dedicated to a career in claims management.

Qualifications

• Prior experience in workers’ compensation as a medical only examiner or equivalent.
• Ability to collaborate with leadership and peers.
• Commitment to a career in claims.

Responsibilities

• Manage all aspects of workers’ compensation lost time claims.
• Conduct ongoing investigations with involved parties.
• Prepare reports on claims evaluations and settlements.

Skills

Exceptional customer service

Data analytics

Time management

Verbal communication

Written communication

Collaboration

Analytical skills

Education

Experience in workers’ compensation

Knowledge of workers’ compensation statutes

Job description

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

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 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 as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.

Qualifications:

• 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.

• Seniority level: Associate
• Employment type: Contract
• Job function: Information Technology
• Industries: IT Services and IT Consulting