Job Title: Claims Examiner-Lost Time Location: New Haven CT USA 06511 Duration: 3 Months (Temp to Perm depend on performance) Job Schedule-Hybrid Job hours-8:30am-5:00pm EST
Job Summary: 3+ years of Workers’ Compensation Lost Time Claim Examiner or commensurate experience is required. While workers' compensation experience is not mandatory, transferable skills are highly valued.
Duties and Responsibilities:
Manage all aspects of workers’ compensation lost time claims from setup to closure, ensuring strong customer relations.
Review claim and policy information for investigative background.
Conduct 3-part ongoing investigations, obtaining facts and statements from insureds, claimants, and medical providers.
Evaluate investigation findings to determine claim compensability.
Inform insureds, claimants, and attorneys of claim denials when applicable.
Prepare investigation reports, settlements, denials, and evaluations.
Administer statutory medical and indemnity benefits in a timely manner.
Set reserves within authority limits and recommend changes as needed.
Review claim status regularly and recommend remedial actions to the Team Leader.
Work with attorneys to manage hearings and litigation.
Coordinate with vendors, nurse case managers, and rehabilitation managers on medical management and return-to-work initiatives.
Ensure compliance with state regulations and statutory requirements.
Refer claims to subrogation to maximize recovery opportunities.
Collaborate with internal teams, including Technical Assistants and Nurse Consultants, to deliver exceptional service.
Technical Skills & Competencies:
Experience as a Lost Time Claim Examiner or in a similar role (medical examiner, paralegal, disability examiner, auto injury claims, etc.).
Knowledge of workers’ compensation statutes, regulations, and compliance.
Ability to incorporate data analytics and modeling in daily activities.
Strong customer service focus and commitment to claims career.
Excellent time management, multi-tasking, and follow-through abilities.
Analytical skills to find mutually beneficial solutions to claims.
Ability to deliver presentations to internal and external customers.
Strong verbal and written communication skills.
Willingness to tackle obstacles and meet service standards.
Experience, Education & Requirements:
Experience in a fast-paced, customer-focused environment.
Strong telephonic communication and organizational skills.
Prior workers’ compensation claims experience is a plus but not required.
Familiarity with healthcare or general liability claims is a plus but not required.
Insurance, legal, or corporate business experience is a plus but not required.
AIC, RMA, or CPCU coursework/designation is a plus but not required.
Proficiency in Microsoft Office products.
Knowledge of medical terminology and bill processing is a plus.
Claim Adjuster licenses in Connecticut, New Hampshire, Rhode Island, and Vermont are required, but not at the time of posting. Licenses must be obtained during employment if not already held.
About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.
Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer.
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $36.22/hr.
