Claims Examiner-Lost Time
6 days ago
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.• 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.
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