Claims Examiner Lost Time

JOB DESCRIPTION

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 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, 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