Workers Compensation Lost Time Claim Examiner
Company: ICONMA, LLC
Location: Alpharetta
Posted on: January 18, 2023
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Job Description:
Workers Compensation Lost Time Claim Examiner
Location: Alpharetta, GA/Hybrid
Duration: 6 months with Possible Contract Hire
Description:
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.
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Keywords: ICONMA, LLC, Alpharetta , Workers Compensation Lost Time Claim Examiner, Other , Alpharetta, Georgia
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