[ref. a20904604] Claims Examiner-Lost Time

We are inviting applications for a Claims Examiner-Lost Time role based in New Haven, Connecticut. This role resides in the insurance industry and provides an opportunity to work in a hybrid workplace. The position offers a short-term contract employment opportunity and involves handling all aspects of workers' compensation lost time claims, maintaining customer relations, and ensuring compliance with statutory regulations.

Responsibilities:

• Administer all aspects of workers' compensation lost time claims from initiation to closure, maintaining strong customer relations throughout the process.
• Evaluate claim and policy information to form a basis for investigation.
• Conduct ongoing investigations, obtaining facts and taking statements from insured claimants and medical providers when necessary.
• Evaluate facts obtained through investigations to determine the compensability of the claim.
• Inform insureds, claimants, and attorneys of claim denials when applicable.
• Prepare reports on investigation settlements, denials of claims, and evaluations of involved parties.
• Administer statutory medical and indemnity benefits in a timely manner throughout the life of the claim.
• Manage hearings and litigation in collaboration with attorneys.
• Direct and control vendors, nurse case managers, telephonic cases managers, and rehabilitation managers on medical management and return to work initiatives.
• Ensure compliance with statutory regulations by filing workers' compensation forms and electronic data with states.
• Collaborate with in-house Technical Assistants, Special Investigators, Nurse Consultants, and Team Supervisors to exceed customer's expectations for exceptional claims handling service. • Proven experience in customer service and communication
• Knowledge of procedures, policy, and compliance in the insurance sector
• Quality assurance and human resources administration skills
• Experience in insurance claims and medical coverage
• Ability to manage benefit functions and handle vendors
• Knowledge of claim administration and regulation
• Proficiency in expense reporting and financial notes
• Excellent time management and teamwork skills
• Proficiency in Microsoft Office Suites and consumer electronics
• Familiarity with HealthCare.gov and litigation procedures
• Leadership skills to guide and manage team
• Ability to ensure compliance with all relevant laws and regulations.