Job Schedule: Hybrid
Hours: 8:30 AM - 5:00 PM EST
MUST HAVE: Claim Adjuster licenses in Connecticut, New Hampshire, Rhode Island, and Vermont are necessary; however, they are not required at the time of application. If not already licensed, candidates will need to obtain an applicable resident or designated home state adjuster license and potentially additional state licenses.
Experience:
3+ years as a Workers’ Compensation Lost Time Claim Examiner or equivalent experience. While prior workers’ compensation experience is advantageous, transferable skills from related fields are acceptable.
Duties and Responsibilities:
- Manage all aspects of workers’ compensation lost time claims from initiation to closure, ensuring strong customer relationships throughout the process.
- Review claim and policy information to provide context for investigations.
- Conduct thorough, three-part ongoing investigations, gathering facts and statements from the insured, claimants, and medical providers as necessary.
- Evaluate investigation findings to determine the compensability of claims.
- Notify insureds, claimants, and attorneys of any claim denials when applicable.
- Prepare detailed reports on investigations, settlements, claim denials, and evaluations of involved parties.
- Administer statutory medical and indemnity benefits promptly throughout the claim's lifecycle.
- Set reserves for medical, indemnity, and expenses within authorized limits, recommending changes to the Team Leader as needed.
- Regularly review claim status and advise the Team Leader on issues and potential solutions.
- Report unusual or potentially problematic exposures to the Team Leader.
- Collaborate with attorneys to manage hearings and litigation.
- Oversee and guide vendors, nurse case managers, telephonic case managers, and rehabilitation managers on medical management and return-to-work initiatives.
- Fulfill 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 regulatory compliance.
- Refer appropriate claims to subrogation and gather necessary information to maximize recovery opportunities.
- Work closely with Technical Assistants, Special Investigators, Nurse Consultants, Telephonic Case Managers, and Team Supervisors to provide exceptional claims handling service.
Technical Skills & Competencies:
- Experience in a Lost Time Claim Examiner role, with a background in workers’ compensation as a medical-only examiner or equivalent experience in paralegal work, short-term/long-term disability, auto personal injury protection, general liability, or as a claims technical assistant for lost time claims.
- Knowledge of workers’ compensation statutes, regulations, and compliance is essential.
- Ability to use data analytics and modeling to expedite fair resolutions of claims and issues.
- Strong focus on customer service.
- Collaborative mindset for achieving goals with leadership and peers.
- Commitment to a career in claims.
- Exceptional time management and multi-tasking skills with consistent follow-through to meet deadlines.
- Analytical skills for finding mutually beneficial solutions to claim and customer issues.
- Ability to create and deliver exceptional presentations to internal and external stakeholders.
- High standards for the quality and professionalism of work and relationships with colleagues and clients.
- Willingness to take ownership and address challenges to meet quality standards in service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
- Superior verbal and written communication skills.
Experience, Education & Requirements:
- Experience in a customer-focused, fast-paced environment.
- Strong communication and telephonic skills.
- High level of organization, follow-up, and accountability in previous roles.
- Prior experience in workers’ compensation claims handling is a plus but not mandatory.
- Familiarity with claim handling in healthcare, short-term/long-term disability, auto personal injury protection, or general liability is beneficial but not required.
- Experience in insurance, legal, or corporate business settings is a plus but not required.
- Completion of coursework or designations such as AIC, RMA, or CPCU is a plus but not required.
- Proficiency in Microsoft Office products.
- Knowledge of medical terminology is a plus but not required.
- Familiarity with 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 application. If not already licensed, candidates will need to obtain an applicable resident or designated home state adjuster license and potentially additional state licenses.
This position will be based in our New Haven, Connecticut office under a 3/2 hybrid model.
JOB ID: 80564
