Claims Examiner-Lost Time

We are offering a long-term contract employment opportunity for a Claims Examiner-Lost Time in Jersey City, New Jersey. This role is within the insurance industry and involves handling all aspects of workers compensation lost time claims. As a Claims Examiner-Lost Time, you will be responsible for maintaining strong customer relations throughout the process and ensuring compliance with statutory regulations.

Responsibilities:

• Ensuring accurate and efficient processing of workers compensation lost time claims from initiation to closure
• Conducting detailed investigations, gathering facts, and taking necessary statements from insured claimants and medical providers
• Evaluating the information obtained through investigations to determine the compensability of the claim
• Communicating with insureds, claimants, and attorneys about claim denials when applicable
• Preparing comprehensive reports on investigations, settlements, denials of claims, and evaluations of involved parties
• Administering statutory medical and indemnity benefits in a timely manner throughout the life of the claim
• Setting reserves for medical, indemnity, and expenses within authority limits and recommending reserve changes to team leaders
• Regularly reviewing claim status and discussing problems and remedial actions with team leaders
• Collaborating with attorneys to manage hearings and litigation
• 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
• Maximizing recovery opportunities by referring appropriate claims to subrogation and securing necessary information
• Working with in-house Technical Assistants, Special Investigators, and Nurse Consultants to exceed customer's expectations for exceptional claims handling service. • Proficiency in Customer Service
• Excellent Communication skills
• Understanding of Procedures and Policy
• Compliance and Quality assurance know-how
• Experience in Human Resources (HR) Administration
• Familiarity with Insurance industry and standards
• Ability to make effective Presentations
• Knowledge of 'About Time' software
• Understanding of Medical Coverage protocols
• Experience in Benefit Functions management
• Demonstrated Leadership Skills
• Experience dealing with Vendors
• Proficiency in Claim Administration
• Understanding of Regulation in the insurance sector
• Ability to manage Expense Reporting
• Experience with Financial Notes
• Exceptional Time Management skills
• Familiarity with Consumer Electronics
• Ability to work effectively in a TeamWork environment
• Proficiency in Microsoft Office Suites
• Understanding of Litigation procedures
• Familiarity with HealthCare.gov platform
• Ability to Ensure Compliance in all processes