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Comptech Associates · 4 weeks ago

Lost Time Claims Examiner

New Haven, CT

Contract

Onsite

Mid Level

Comptech Associates is looking for a Claims Examiner-Lost Time to manage all aspects of workers’ compensation lost time claims. The role involves conducting investigations, evaluating claims, and ensuring compliance with statutory regulations while maintaining strong customer relations.

Information ServicesInformation Technology

Growth Opportunities

Hiring Manager

Abhishek Singh

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

Qualification

Workers' compensation knowledgeClaims management experienceData analytics skillsExceptional customer serviceTime management skillsAnalytical skillsCollaboration skillsPresentation skillsVerbal communicationWritten communication

Required

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