Claims Examiner-Lost Time

Job Description

Job Description

We are looking for a skilled Claims Examiner specializing in lost time claims to join our team on a contract basis in Jersey City, New Jersey. In this role, you will oversee the full lifecycle of workers' compensation claims, ensuring compliance with regulations while maintaining strong relationships with all involved parties. This position requires someone with excellent attention to detail, capable of managing complex claims processes and delivering high-quality service.

Responsibilities:
• Manage workers' compensation lost time claims from initial setup to closure, maintaining excellent customer relationships throughout the process.
• Conduct thorough investigations by reviewing policy details, collecting statements, and gathering facts from claimants, insured parties, and medical providers.
• Evaluate gathered information to determine claim compensability and communicate decisions regarding claim approvals or denials to all relevant parties.
• Administer statutory medical and indemnity benefits in a timely manner, ensuring compliance with applicable regulations.
• Set and adjust claim reserves for medical, indemnity, and related expenses, recommending changes to the Team Leader as necessary.
• Partner with attorneys to oversee litigation processes, including hearings, and manage legal documentation.
• Direct and coordinate efforts with vendors, nurse case managers, and rehabilitation managers to support medical management and return-to-work initiatives.
• Prepare and submit reports on claim settlements, denials, evaluations, and potential exposures to the Team Leader.
• Ensure compliance with state regulations by filing workers' compensation forms and electronic data accurately and on time.
• Identify subrogation opportunities and work to recover claim-related costs effectively.• Minimum of 3 years of experience as a Workers' Compensation Lost Time Claims Examiner or equivalent claims-handling experience in related fields.
• Strong knowledge of workers' compensation statutes, regulations, and compliance requirements.
• Previous exposure to claims involving medical, disability, auto insurance, or general liability is preferred.
• Proficiency in customer service and communication to effectively manage relationships with insured parties, claimants, and legal representatives.
• Experience with litigation processes, including working with attorneys and preparing for hearings.
• Ability to manage and prioritize multiple claims while meeting deadlines and maintaining high-quality standards.
• Familiarity with Microsoft Office Suite and other relevant software tools.
• Strong analytical and decision-making skills for assessing claim compensability and setting reserves.