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Claims Examiner

ICONMA, LLC

New Haven, CT

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JOB DETAILS
SALARY
$1–$35.91 Per Hour
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, Health Plan, 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, 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
8 days ago
Our client, a Property and Casualty Insurance company, is looking for a Claims Examiner for their New Haven, CT location.
 
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.
 
Requirements:
  • 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.)
  • 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’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, 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
 
Why Should You Apply?

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ICONMA, LLC

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