Claims Examiner

Job Title: Claims Examiner- Lost TimeLocation: New Haven, CT 06511Expected Duration: 3 months to start offShift: Monday through Friday (8:30 am-5:00 pm EST)100% Onsite Description: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 TeamLeader 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, NurseConsultants, 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 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 licensureCompany DescriptionAbout BCforward:Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class places to work.BCforward is an equal opportunity employer.

Salary : $29 - $39