Claims Examiner

Workers’ Compensation Claim Examiner

Contract Duration: 3 months, possible extension
Location: New Haven, CT
Work Arrangement: Onsite
Pay Range: $35-40 per hour

Summary
We’re seeking an experienced Claim Examiner to manage workers’ compensation claims from initial setup through resolution. Prior workers’ compensation claim handling is a plus, but not required—if you bring transferable claims or related experience and strong investigative, analytical, and customer service skills, we’d like to hear from you.

What You’ll Do

• Handle end-to-end claims management from setup through closure while maintaining strong customer relationships.
• Review claim and policy information to support investigations.
• Conduct ongoing, multi-party investigations—gathering facts and statements from insureds, claimants, medical providers, and others as needed.
• Evaluate investigation results to determine claim compensability.
• Communicate claim decisions (including denials when applicable) to insureds, claimants, and attorneys.
• Prepare clear, timely documentation and reports related to investigations, settlements, denials, evaluations, and claim activity.
• Administer statutory medical and/or indemnity benefits accurately and on time throughout the life of the claim.
• Set and manage claim reserves within authority limits; recommend reserve changes to the Team Leader as needed.
• Review claim status regularly and escalate issues, risks, and recommended solutions to leadership.
• Identify unusual exposures and communicate potential concerns promptly.
• Partner with attorneys to manage hearings and litigation.
• Coordinate and direct vendors and clinical/return-to-work partners (e.g., nurse case managers, telephonic case managers, rehab managers) to support medical management and return-to-work outcomes.
• Meet customer service requests, including special handling procedures, file status notes, and claim reviews.
• File required workers’ compensation forms and electronic reporting with states to ensure regulatory compliance.
• Identify subrogation opportunities and refer claims appropriately, gathering necessary documentation to support recovery.
• Collaborate with internal teams (technical assistants, investigators, nurse consultants, supervisors) to deliver exceptional claims handling service.

What You Bring

• Experience: 3+ years as a Claim Examiner or commensurate experience with transferable skills.
• Prior experience in one or more of the following is helpful: workers’ compensation, paralegal work, short-term/long-term disability, auto personal injury protection (PIP)/medical injury, general liability, medical billing, or claims technical support (especially lost time claims).
• Working knowledge of workers’ compensation statutes, regulations, and compliance (or the ability to learn quickly).
• Strong investigative and analytical skills, including the ability to apply data and insights to support fair and timely outcomes.
• Customer-focused mindset with a commitment to professionalism and quality.
• Strong organization, time management, and follow-through in a high-volume environment.
• Ability to collaborate openly with peers and leadership to meet team goals.
• Excellent verbal, written, and phone-based communication skills.
• Ability to prepare and deliver clear presentations to internal and external stakeholders.
• Proficiency with Microsoft Office (Outlook, Excel, Word, etc.).

Preferred (Not Required)

• Prior workers’ compensation claim handling experience.
• Knowledge of medical terminology and/or bill processing.
• Insurance, legal, or corporate business background.
• AIC, RMA, or CPCU coursework or designation(s).

Licensing

Claim Adjuster licenses in Connecticut, New Hampshire, Rhode Island, and Vermont are necessary; however, they are not required at the time of application. If you do not currently hold these licenses, you will be required to obtain an applicable resident or designated home-state adjuster license and may need to secure additional state licensure.

Work Environment

• Customer-focused, fast-paced, and fluid environment.
• Role requires strong accountability, organization, and consistent follow-up.