Claims Examiner - Lost Time
Claims Examiner - Lost Time
Posted on :
04-11-2024
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Posted on :
04-11-2024
Job Description
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:
Handles all aspects of workers compensation lost time claims from setup to case closure ensuring strong customer relations are maintained throughout the process.
Reviews claim and policy information to provide background for investigation.
Conducts 3part 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 inhouse Technical Assistants Special Investigators Nurse
Consultants Telephonic Case Managers as well as Team Supervisors to exceed customers 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 shortterm / longterm 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 multitasking 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 coworkers and clients.
Willing to take ownership and tackle obstacles to meet our 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 fastpaced fluid environment
Experience utilizing strong communication and telephonic skills
Prior experience requiring a high level of organization followup and accountability
Prior workers compensation claim handling experience is a plus but not required
Familiarity with claim handling (healthcare shortterm / longterm 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
Duties and Responsibilities:
Handles all aspects of workers compensation lost time claims from setup to case closure ensuring strong customer relations are maintained throughout the process.
Reviews claim and policy information to provide background for investigation.
Conducts 3part 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 inhouse Technical Assistants Special Investigators Nurse
Consultants Telephonic Case Managers as well as Team Supervisors to exceed customers 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 shortterm / longterm 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 multitasking 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 coworkers and clients.
Willing to take ownership and tackle obstacles to meet our 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 fastpaced fluid environment
Experience utilizing strong communication and telephonic skills
Prior experience requiring a high level of organization followup and accountability
Prior workers compensation claim handling experience is a plus but not required
Familiarity with claim handling (healthcare shortterm / longterm 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
Employment Type
Full Time
Key Skills
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