Claims Examiner

Claims Examiner

Our client, a Property and Casualty Insurance company, is looking for a Claims Examiner for their New Haven, CT location. Responsibilities include:

• Handling all aspects of workers' compensation claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
• Reviewing claim and policy information to provide background for investigation.
• Conducting 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant, and medical providers.
• Evaluating the facts gathered through the investigation to determine compensability of the claim.
• Informing insureds, claimants, and attorneys of claim denials when applicable.
• Preparing reports on investigation, settlements, denials of claims and evaluations of involved parties, etc.
• Timely administration of statutory medical and/or indemnity benefits throughout the life of the claim.
• Setting reserves within authority limits for medical, indemnity and expenses and recommending reserve changes to Team.
• Reviewing the claim status at regular intervals and making recommendations to Team Leader to discuss problems and remedial actions to resolve them.
• Preparing and submitting to Team Leader unusual or possible undesirable exposures when encountered.
• Working with attorneys to manage hearings and litigation.
• Controlling and directing vendors, nurse case managers, telephonic case managers and rehabilitation managers on medical management and return to work initiatives.
• Complying with customer service requests including Special Claims Handling procedures, file status notes and claim reviews.
• Filing workers' compensation forms and electronic data with states to ensure compliance with statutory regulations.
• Referring appropriate claims to subrogation and securing necessary information to ensure that recovery opportunities are maximized.
• Working 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.

Requirements include:

• Claim Examiner position with prior experience in workers' compensation as a claim examiner, or commensurate examiner experience in paralegal, short-term / long-term disability, auto personal injury protection / medical injury, general liability, medical billing or as a claim technical assistant for lost time claims.
• 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 quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
• Superior verbal and written communication skills.
• 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.
• Familiarity with claim handling (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, medical billing, 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.

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities