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Workers Compensation Lost Time Claim Examiner

Company: ICONMA, LLC
Location: Alpharetta
Posted on: January 18, 2023

Job Description:

Workers Compensation Lost Time Claim Examiner

Location: Alpharetta, GA/Hybrid
Duration: 6 months with Possible Contract Hire

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 Supervisor throughout the life of the claim.
Reviews the claim status at regular intervals and makes recommendations to Supervisor to discuss problems and remedial actions to resolve them.
Prepares and submits to Supervisor 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 similar examiner experience in 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
Bachelors Degree 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 license in Georgia is required.
Adjuster licenses in other states are preferred but not required.


Keywords: ICONMA, LLC, Alpharetta , Workers Compensation Lost Time Claim Examiner, Other , Alpharetta, Georgia

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