Description We are looking for an experienced Claims Examiner specializing in Lost Time claims to join our team in Jersey City, New Jersey. This is a long-term contract position that requires strong expertise in workers' compensation and claims administration. The ideal candidate will manage lost time claims from initiation to closure, ensuring compliance with regulations and delivering exceptional service to all stakeholders.
Responsibilities:
Manage all aspects of workers' compensation lost time claims, from initial setup to final resolution, while maintaining strong relationships with claimants and insured parties.
Investigate claims by reviewing policy information, conducting interviews, and gathering relevant facts to assess compensability.
Communicate claim decisions, including denials, to insureds, claimants, and legal representatives in a meticulous manner.
Prepare detailed reports on investigations, settlements, claim evaluations, and other related activities.
Administer statutory medical and indemnity benefits throughout the claim process, ensuring timely and accurate management.
Establish and adjust reserves for medical, indemnity, and expenses within authority limits and collaborate with team leaders for necessary changes.
Collaborate with attorneys to manage hearings, litigation, and other legal proceedings.
Oversee vendors, nurse case managers, and rehabilitation specialists to ensure effective medical management and return-to-work initiatives.
Ensure compliance with statutory regulations by filing relevant workers' compensation forms and electronic data with state authorities.
Identify subrogation opportunities and gather necessary documentation to maximize recovery potential. Requirements - Minimum of three years' experience as a Workers' Compensation Lost Time Claim Examiner or equivalent experience in claims handling.
Familiarity with workers' compensation statutes, regulations, and compliance requirements.
Proven ability to manage complex claims investigations and incorporate data analytics into decision-making processes.
Strong communication and customer service skills to effectively interact with insureds, claimants, attorneys, and other stakeholders.
Proficiency in managing litigation and collaborating with legal teams.
Knowledge of medical management practices and return-to-work strategies.
Competency in using Microsoft Office Suite and other relevant software for documentation and reporting.
Highly organized with excellent time management skills to handle multiple claims efficiently.
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.
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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.
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