Sign upLog in

Claims Examiner

Sunrise Systems Inc

New Haven, CT

Apply
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, Healthcare, Healthcare Providers, Information/Data Security (InfoSec), Insurance, Inventory Management, Investigative Reports, Leadership, Legal, Litigation, Maintain Compliance, Medical Billing, Medical Terminology, Microsoft Office, Microsoft Product Family, Multitasking, Nursing, Paralegal, Personal Injury, Presentation/Verbal Skills, Problem Solving Skills, 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
7 days ago
Job Title: Claims Examiner - Workers Compensation
Location: New Haven CT USA 06511-5941
Duration: 3 Months
 
Description:
Job Schedule: 5 days on-site
Job Hours: 8:30am-5:00pm EST
 
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.)
 
Duties and 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 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.
 
Technical Skills & Competencies:
  • Claim Examiner position with prior experience in workers’ compensation as a claim examiner, or commensurate examiner experience in paralegal, short-term / long-term disability, auto personal injury protection / medical injury, general liability, medical billing 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 quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
  • Superior verbal and written communication skills.
 
Experience, Education & Requirements:
  • 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, medical billing, 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
  • Claim Adjuster licenses in Connecticut, New Hampshire, Rhode Island and Vermont, are necessary; however, they are not required at the time of posting for the position. If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure
 
Ghouse: Ghouse.M@sunrisesys.com | (732) 395-4372 | URL: www.sunrisesys.com
 
 

About the Company

S

Sunrise Systems Inc

Sunrise Systems was founded in 1990 with a clear vision to deliver world-class staffing service solutions in all labor categories, including IT consulting and solutions; all with the commitment to provide service that exceeds expectations and become the most trusted name in the industry. More than two and a half decades later, we pride ourselves on being at the forefront of the staffing industry. Combining our deep industry expertise, insights, and global resources, we have partnered with our clients to connect them with top professionals across several different industries.

We provide cost-effective Managed Staffing Solutions, Information Technology and Information Technology Consulting Services to several Fortune 500 companies and U.S. Government agencies. We provide our clients with flexible engagement models and customized products that are budget and time specific. Understanding the challenges that every business faces, we offer our services either on-site at the clients' site or from one of our globally distributed technology centers. Our onshore and offshore development capabilities ensure that we excel at meeting customer requirements every single time.

Our collective business experience spans over two and a half decades and ranges from:

  • Business, management, and technical fields
  • Information technology consulting and software solutions.
  • Providing strategic support for the development and long-term growth of new business ventures across several industries including but not limited to; accounting, banking, finance, and recruitment.
  • Motivating technology staff and establishing partnerships with Fortune 500 companies

Sunrise Systems has a vast range of competence in:

  • Design, development, and support of cloud-based solutions from simple to highly complexed
  • Database administration of multi-platform applications, complex databases, and web-based environments that include all aspects of installation, planning, maintenance, and monitoring.
  • Data processing and data migration
  • Application re-engineering and platform migration
  • Working with the Information Systems and end-user communities at all levels to resolve issues and establish consensus.
COMPANY SIZE
100 to 499 employees
INDUSTRY
Staffing/Employment Agencies
FOUNDED
1990
WEBSITE
http://www.sunrisesys.com/

Resume Resources

Free Resume TemplatesFree Resume Builder