Claims Examiner-Lost Time, Robert Half

Claims Examiner-Lost Time

Robert Half

Location:

United States, New Haven

Category:

Insurance

Contract Type:

Not provided

Salary:

Not provided

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Job Description:

This role primarily functions in the insurance industry and involves handling all aspects of workers compensation lost time claims. The successful candidate will be expected to maintain strong customer relations throughout the process, from setup to case closure.

Job Responsibility:

Handling all components of workers compensation lost time claims, from initiation to closure, maintaining strong customer relations throughout
Thoroughly reviewing claim and policy information to establish a basis for investigation
Conducting comprehensive investigations, obtaining facts and statements from insured claimants and medical providers
Evaluating facts gathered through investigations to determine the compensability of the claim
Informing insureds, claimants, and attorneys of claim denials, when applicable
Preparing 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 Leader
Regularly reviewing claim status and making recommendations to Team Leader to discuss problems and remedial actions
Working with attorneys to manage hearings and litigation
Directing vendors, nurse 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
Collaborating with in-house Technical Assistants, Special Investigators, Nurse Consultants, Telephonic Case Managers, and Team Supervisors to exceed customer's expectations for exceptional claims handling service

Requirements:

Proficient in Customer Service
Strong Communication skills
Understanding of Procedures and Policies
Knowledge of Compliance and Quality standards
Experience in Human Resources (HR) Administration
Familiarity with Insurance industry
Ability to create and deliver Presentations
Knowledge about Time management
Understanding of Medical Coverage and Benefit Functions
Demonstrated Leadership Skills
Experience working with Vendors
Familiarity with Claim Administration
Understanding of Regulation in the insurance sector
Experience with Expense Reporting and Financial Notes
Excellent Time Management skills
Knowledge of Consumer Electronics
Ability to work in a Team
Proficiency in Microsoft Office Suites
Experience in Litigation
Familiarity with HealthCare.gov
Ability to Ensure Compliance

What we offer:

medical, vision, dental, and life and disability insurance
eligibility to enroll in company 401(k) plan

Additional Information:

Job Posted:

March 23, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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