Comptech Associates
Lost Time Claims Examiner (New Haven)
Comptech Associates, New Haven, Connecticut, United States, 06540
About the Role:
Job Title:
Claims Examiner-Lost Time Location:
555 Long Wharf Drive, New Haven, CT. 06511 Duration:
3 months
Job Schedule:
5 days on-site Job Hours:
8:30am-5:00pm EST 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 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.
Job Title:
Claims Examiner-Lost Time Location:
555 Long Wharf Drive, New Haven, CT. 06511 Duration:
3 months
Job Schedule:
5 days on-site Job Hours:
8:30am-5:00pm EST 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 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.