Job Information
TEKsystems Claims Examiner in New Haven, Connecticut
Overview:
As a claims Examiner you will conduct a 3 part ongoing investigation to obtain facts and statements as necessary with insured claimant and medical providers for workers compensation claims. You will be an acting member of one of the largest Insurance Organizations in the state of Connecticut, being able to grow and expand you skillset within the company.
Additional Responsibilities include:
Handles all aspects of workers compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.
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.
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 designations 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
About TEKsystems:
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.