Claims Examiner Job at Sunrise Systems, Inc., New Haven, CT

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  • Sunrise Systems, Inc.
  • New Haven, CT

Job Description

Job Title: Claims Examiner-Lost Time

Location: 555 Long Wharf Drive New Haven CT USA 06511-5941

Duration: 3 Months (Possible Extension or Conversion)

Position Type: Hourly contract Position (W2 only)

Job Schedule: 5 days on-site

Job Hours: 8:30am-5:00pm EST

Interview Process: 1 round of interview – Virtual

  • 3+ years of Workers' Compensation Lost Time 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.)

Duties and Responsibilities:

  • Handles all aspects of workers' compensation lost time 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 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.

Technical Skills & Competencies:

  • Lost Time Claim Examiner position with prior experience in workers' compensation as a medical only examiner, or commensurate examiner experience in paralegal, short-term / long-term disability, auto personal injury protection / medical injury, general liability 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, Education & Requirements:
  • 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, 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
  • Claim Adjuster licenses in Connecticut, New Hampshire, Rhode Island and Vermont, are necessary; however, they are not required at the time of posting for the position.
  • If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.

Contact:

Abdul Ajeej: abdul.a@sunrisesys.com | (732) 515-5288 | URL:

Job Tags

Hourly pay, Contract work, Temporary work, Work at office,

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