Claims Examiner-Lost Time
Iconma
New Haven, CT
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JOB DETAILS
SKILLS
Analysis Skills, Background Investigation, Bill Of Process (BOP), Case Management, Certified Case Manager (CCM), Claims Processing, Communication Skills, Customer Relations, Customer Support/Service, Data Analysis, Data Modeling, Diversity, Follow Through, Genetics, Health Plan, Healthcare, Healthcare Providers, Information/Data Security (InfoSec), Insurance, Inventory Management, Investigative Reports, Leadership, Legal, Litigation, Maintain Compliance, Medical Terminology, Microsoft Office, Microsoft Product Family, Multitasking, Nursing, Paralegal, Personal Injury, Presentation/Verbal Skills, Problem Solving Skills, Property and Casualty Insurance, Quality Metrics, Regulatory Compliance, Rehabilitation Medicine, Reporting Skills, Subrogation, Team Lead/Manager, Team Player, Time Management, Worker's Compensation, Writing Skills
LOCATION
New Haven, CT
POSTED
28 days ago
Our Client, a Property And Casualty Insurance company, is looking for a Claims Examiner-Lost Time for their New Haven, CT location.
Responsibilities:
Requirements:
Why Should You Apply?
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
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.
Requirements:
- 3+ years of Workers’ Compensation Lost Time 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.)
- 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.
- Experience working in a customer focused, fast-paced, fluid environment
- Experience utilizing strong communication and telephonic skills
- Prior experience requiring a high level of organization, follow-up and accountability
- Prior workers’ compensation claim handling experience is a plus but not required
- Familiarity with claim handling (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability) is a plus but not required
- Prior insurance, legal or corporate business experience is a plus but not required
- AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
- Proficiency with Microsoft Office Products
- Knowledge of medical terminology is a plus but not required
- Knowledge of bill processing is a plus but not required
Why Should You Apply?
- Health Benefits
- Referral Program
- Excellent growth and advancement opportunities
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
About the Company
I
Iconma
ICONMA is a global information consulting management firm providing Professional Staffing Services and Project-Based Solutions for organizations in a broad range of industries.
- Corporate Headquarters in Troy, Michigan; 20+ locations worldwide.
- Certified Woman-Owned Business Enterprise (WBE); certified by Women’s Business Enterprise National Council, National Women Business Owners Corporation (NWBOC); and California Public Utilities Commission (CPUC).
- Founded in 2000
- 2000+ Employees
The company was founded on the principle that success is derived from delivering high quality service and resources in the most responsive, flexible, and innovative way. ICONMA invests in people and resources with a single goal: To provide our customers with the highest quality service in the most responsive manner. Through its network of offices, ICONMA provides the resources to help clients maintain their competitive advantage.
COMPANY SIZE
2,000 to 2,499 employeesINDUSTRY
Management Consulting Services
EMPLOYEE BENEFITS
401K, Life Insurance, Medical, Dental and Vision, Employee Referral Program
FOUNDED
2000
WEBSITE
https://www.iconma.com/