Claims Examiner Job Listing at Kelly Services in New Haven, CT (Job ID US3574389_BH9863917)

Description

Finding a Hybrid job that fits your lifestyle isn't always easy. That's where Kelly comes in. We're seeking a Claims Examiner to work at a premier client in New Haven CT 06511.

Pay rate and Shift
l Job Duration: 3+ Month
l Shift:  Mon to Fri Hybrid (3 day onsite )

Job Summary:

• 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 Team
• Leader throughout the life of the claim.
• Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.
• Prepares and submits to Team Leader 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.

Key Responsibilities:
l Responsible for compliance with applicable policies and procedures. Demonstrates knowledge of external guidelines (e.g., FDA, PhRMA) to ensure compliance.
l Responsible for negotiating and contracting for consulting and/or promotional speaking services in a timely manner.
l Identify, develop, and implement improved and standardized contracting practices to ensure the most efficient processes for the business. Educate key stakeholders on the same. Seek innovative solutions for the consulting and/or speaker process, develop action plans and participate in cross-functional teams.
l Requires broad range understanding of academic and industry experiences as they relate to consultant and speaker contracting
l Develop standard guidelines and updates associated with the consulting and/or speaker contracting process. In-depth knowledge of all compliance requirements and the implications of compliance incidents.
l Act as an interface for assigned therapeutic area globally.
l Provide support to ensure continuous improvement in consultant interface to ensure the best experience possible for our key opinion leaders and patients. Seek, develop, and establish business relationships with multiple groups across the organization including all areas of Legal, Commercial operations, medical affairs, R&D.
l Meet regularly with Stakeholders and support functions to ensure customer satisfaction and continuous improvement Seek, develop, and maintain business relationships with areas across the organization.
l Expert in the use of procurement tools including but not limited to; SAP, consulting and/or speaker program contracting systems, contract management.
l Proactive management of contracts, business stakeholders and consultants including, anticipation, resolution, and communication.
l Effectively develops and negotiates agreements with key opinion leaders, patients, and advocacy executives.
l Develops and maintains necessary files and records to maximize performance and ability to multi-task in a fast-paced environment without supervision. Understand and apply cultural awareness with US and OUS business entities.

TOP 3 MUST HAVES:

• Lost Time Claim Examiner position with prior experience in workers' compensation as a medical only examiner, or commensurate examiner experience in paralegal, 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.
•  
• Qualifications and Experience:
  
  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
  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 licenses in Connecticut, New Hampshire, Rhode Island and Vermont, are necessary; however, they are not required at the time of posting for the position. If you do not already have one, you will be required to obtain an applicable resident or designated home state adjusters license and possibly additional state licensure.
  
  What happens next:
  Once you apply, you'll proceed to next steps if your skills and experience look like a good fit. But don't worry-even if this position doesn't work
  out, you're still in our network. That means all of our recruiters will have access to your profile, expanding your opportunities even more.
  Helping you discover what's next in your career is what we're all about, so let's get to work.
  Apply to be an Claims Examiner today!
  #P3
  #CB

As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan. Click here for more information on benefits and perks that may be available to you as a member of the Kelly Talent Community.

Get a complete career fit with Kelly®.

You're looking to keep your career moving onward and upward, and we're here to help you do just that. Our staffing experts connect you with top companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in your career.

About Kelly

Work changes everything. And at Kelly, we're obsessed with where it can take you. To us, it's about more than simply accepting your next job opportunity. It's the fuel that powers every next step of your life. It's the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life—just ask the 300,000 people we employ each year.

Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California's state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

 Apply on company website