Job Description
Job Description
Job Title: Insurance Claims Examiner
Location: 555 Long Wharf Drive, New Haven, CT 06511 (Onsite)
Duration: 3 Months Contract (Temp to Perm)
Employment Type: W2 Hourly Contract
Work Schedule: Monday–Friday | 8:30 AM – 5:00 PM EST | 100% Onsite
Job Summary
We are seeking an experienced Claims Examiner – Lost Time to manage workers’ compensation lost time claims from initial setup through closure. The ideal candidate will have strong investigation, analytical, and customer service skills, and the ability to manage claims in a fast-paced environment while ensuring compliance with statutory and client requirements.
Key Responsibilities
- Handle all aspects of workers’ compensation lost time claims from setup to closure while maintaining strong customer relationships.
- Review claim and policy information to establish investigation strategy.
- Conduct ongoing 3-part investigations involving insureds, claimants, and medical providers.
- Evaluate facts to determine claim compensability and communicate decisions clearly.
- Prepare and issue claim denial letters, reports, and settlement documentation as needed.
- Administer statutory medical and indemnity benefits in a timely manner.
- Establish and manage reserves for medical, indemnity, and expense costs; recommend reserve changes as appropriate.
- Regularly review claim status and escalate complex issues to the Team Leader with recommendations.
- Identify and report unusual exposures or potential risks.
- Work closely with attorneys to manage litigation, hearings, and legal proceedings.
- Coordinate with nurse case managers, telephonic case managers, rehab vendors, and other partners to support medical management and return-to-work initiatives.
- Ensure compliance with state regulations by filing required workers’ compensation forms and electronic data.
- Refer appropriate claims to subrogation and support recovery efforts.
- Collaborate with internal teams including Technical Assistants, Investigators, Nurse Consultants, and Supervisors to deliver exceptional service.
Required Skills & Competencies
- 3+ years of claims handling experience (workers’ compensation lost time preferred; transferable experience accepted).
- Strong knowledge of claims investigation, evaluation, and resolution processes.
- Working knowledge of workers’ compensation statutes and compliance requirements (preferred).
- Excellent customer service, communication, and negotiation skills.
- Strong analytical, organizational, and time management abilities.
- Ability to manage multiple claims, prioritize effectively, and meet deadlines.
- Proficiency in Microsoft Office (Word, Excel, Outlook).
- Ability to work collaboratively with leadership and peers.
- High level of professionalism, accountability, and attention to detail.
Preferred Experience
- Workers’ compensation (medical-only or lost time) claims handling
- Paralegal, disability (STD/LTD), auto PIP, general liability, or medical injury claims experience
- Insurance, legal, or corporate business background
- Knowledge of medical terminology and bill processing
- AIC, RMA, CPCU coursework or designation
Company DescriptionFounded in 1990, Sunrise Systems is an award winning IT/Professional Staffing firm to Fortune 500 and State/Local Government Agencies.
Company Description
Founded in 1990, Sunrise Systems is an award winning IT/Professional Staffing firm to Fortune 500 and State/Local Government Agencies.