New Haven, CT, 06532, USA
5 days ago
Claims Examiner-Lost Time
Description We are seeking an experienced Claims Examiner-Lost Time to join our team in New Haven, Connecticut, 06511, United States. In this role, you will be responsible for handling all aspects of workers compensation lost time claims, from setup to case closure. This role offers a short term contract employment opportunity within the insurance industry, where you will maintain strong customer relations throughout the process. Responsibilities: • Handle all aspects of workers compensation lost time claims from set-up to case closure • Review claim and policy information to provide background for investigation • Conduct ongoing investigations, obtaining facts and taking statements as necessary with insured claimant and medical providers • Evaluate the facts gathered through the investigation to determine compensability of the claim • Inform insureds, claimants and attorneys of claim denials when applicable • Prepare reports on investigation, settlements, denials of claims, and evaluations of involved parties • Administer statutory medical and indemnity benefits throughout the life of the claim • Review the claim status at regular intervals and make recommendations to resolve problems • Work with attorneys to manage hearings and litigation • Control and direct vendors, nurse case managers, telephonic cases managers, and rehabilitation managers on medical management and return to work initiatives • Comply with customer service requests including Special Claims Handling procedures, file status notes, and claim reviews • File workers compensation forms and electronic data with states to ensure compliance with statutory regulations • Refer appropriate claims to subrogation and secure necessary information to ensure that recovery opportunities are maximized • Work 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 • Demonstrated proficiency in customer service • Excellent communication skills, both verbal and written • Knowledge and understanding of procedures and policies related to the role • Experience in maintaining compliance with company standards and regulations • Ability to ensure quality in all aspects of work • Experience in Human Resources (HR) Administration is desirable • Knowledge of insurance policies and procedures • Ability to create and deliver presentations • Understanding of time management principles • Familiarity with medical coverage and benefit functions • Leadership skills to guide a team effectively • Experience working with vendors and managing relationships • Knowledge of claim administration procedures • Understanding of regulations related to claims examination • Experience in expense reporting and handling financial notes • Familiarity with consumer electronics • Ability to work effectively in a team • Proficiency in Microsoft Office Suites • Understanding of litigation related to claims examination • Experience with HealthCare.gov and insurance platforms • Ability to ensure compliance with all relevant laws and regulations. Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles. Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more. All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information. © 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .
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