Claims Examiner-Lost Time

Description We are offering a long-term contract employment opportunity for a Claims Examiner-Lost Time in Jersey City, New Jersey. This role is within the insurance industry and involves handling all aspects of workers compensation lost time claims. As a Claims Examiner-Lost Time, you will be responsible for maintaining strong customer relations throughout the process and ensuring compliance with statutory regulations.Responsibilities: Ensuring accurate and efficient processing of workers compensation lost time claims from initiation to closure Conducting detailed investigations, gathering facts, and taking necessary statements from insured claimants and medical providers Evaluating the information obtained through investigations to determine the compensability of the claim Communicating with insureds, claimants, and attorneys about claim denials when applicable Preparing comprehensive reports on investigations, settlements, denials of claims, and evaluations of involved parties Administering statutory medical and indemnity benefits in a timely manner throughout the life of the claim Setting reserves for medical, indemnity, and expenses within authority limits and recommending reserve changes to team leaders Regularly reviewing claim status and discussing problems and remedial actions with team leaders Collaborating with attorneys to manage hearings and litigation Directing vendors, nurse case managers, telephonic case managers, and rehabilitation managers on medical management and return to work initiatives Complying with customer service requests including Special Claims Handling procedures, file status notes, and claim reviews Filing workers compensation forms and electronic data with states to ensure compliance with statutory regulations Maximizing recovery opportunities by referring appropriate claims to subrogation and securing necessary information Working with in-house Technical Assistants, Special Investigators, and Nurse Consultants to exceed customer's expectations for exceptional claims handling service. Requirements Proficiency in Customer Service Excellent Communication skills Understanding of Procedures and Policy Compliance and Quality assurance know-how Experience in Human Resources (HR) Administration Familiarity with Insurance industry and standards Ability to make effective Presentations Knowledge of 'About Time' software Understanding of Medical Coverage protocols Experience in Benefit Functions management Demonstrated Leadership Skills Experience dealing with Vendors Proficiency in Claim Administration Understanding of Regulation in the insurance sector Ability to manage Expense Reporting Experience with Financial Notes Exceptional Time Management skills Familiarity with Consumer Electronics Ability to work effectively in a TeamWork environment Proficiency in Microsoft Office Suites Understanding of Litigation procedures Familiarity with HealthCare.gov platform Ability to Ensure Compliance in all processes Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .