Claims Examiner

About the role

Contract Duration: 3 months, possible extension. Location: New Haven, CT. Work Arrangement: Onsite.

3+ years of Workers’ Compensation Claim Examiner or Commensurate Experience (Having experience in worker’s compensation is not a requirement but a nice thing to have, as long as the skills they do have are transferable.)

Responsibilities

• Handles all aspects of workers’ compensation 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/or indemnity benefits throughout the life of the claim.
• Sets reserves within authority limits for medical, indemnity and expenses and recommends reserve changes to TeamLeader 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