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Claims Analyst in New Haven, CT at CRS Group

Date Posted: 2/9/2018

Job Snapshot

  • Employee Type:
  • Location:
    New Haven, CT
  • Job Type:
  • Experience:
    At least 10 year(s)
  • Date Posted:

Job Description

Claims Analyst
Duration: 2 month contract
Location: Chicago, IL
Overview: The CRS Group is currently looking for a Claims Analyst for one of our clients in the Chicago area. The CRS Group is a nationwide Staffing Firm who works primarily with Fortune 500 and Fortune 1000 corporations.
Job Description:
  • Responsibility for oversight of Clients Workers Compensation Program
  • Responsible for building consensus and managing risk to the Client
  • Responsible for building, maintaining, and managing relationships with claims adjusters, insurers, legal counsel, and other claims related parties

Claims Handling Oversight:
  • Responsibilities include claims monitoring, providing direction to TPA management, and communicating with employees, managers, insurance carriers, doctors, internal and external counsels, and medical networks.  Responds to questions and issues
  • Reviews first reports of injury for red flags, correct coding of injury type, body part, etc. 
  • Advises adjusters of any needed corrections or feedback
  • Reviews TPA initial investigation results and provides feedback and direction to adjuster as necessary
  • Ultimate decision maker on questionable claim approvals and on all denials, relying primarily on experience and complexity of each case. To do so
  • Consults with Director and legal counsel as necessary
  • Works with TPA and legal counsel to ensure timely processing and management of claims
  • Oversees work of TPA, external legal counsel, and others involved with each case, and provides direction as necessary
  • Authorizes nurse case management when applicable
  • Authorizes special investigation, including surveillance, when applicable
  • Reviews and authorizes changes in case reserves and settlement amounts as requested by adjuster in accordance with the Clients special account instructions
  • Oversees activities of external workers compensation attorney for cases involving litigation
  • Works with TPA and legal counsel to identify claims appropriate for full and final settlement    Provide recommendation to Director and, as necessary, the Office of the General Counsel
  • Partners with internal clients, managers, HR partners, union reps, to ensure adherence of internal processes; protocols (i.e., after 1 year. prioritize cases on the KTK report and partner with HRGs on next action steps)
  • Develop, coordinate, implement and administer work procedures and policies for workers' compensation claims
  • Continuously reviews existing administrative procedures for opportunities for improvement in relation to design, practices, implementation, communication
  • Works with location management and third party administrator to successfully return injured worker to work

Administrative Functions:
  • Participates in claims audits and file reviews to ensure compliance with best practices in claims handling, TPA internal processes and Clients specific account instructions for handling
  • Works with TPA and Workers compensation attorney regarding preferred provider network
  • Recommends changes to the network to the Managed Care Committee
  • Works with the Office of Risk Management, analyze claim data and identify trends; Work with the Office of Risk Management and the affected department to develop and implement risk control and risk reduction programs
  • Files annual application with the State of Connecticut Insurance Department for self-insurance status
  • File required reports to the State of Connecticut Insurance Department and to the State of Connecticut Treasurers office
  • Serves as the subject matter expert to answer questions regarding process, regulations, or complex issues. Maintain and continuously update current knowledge of Connecticut Workers' Compensation Laws
  • Attends conferences, provides updates to leadership on findings, trends, best practices, etc. and seek to implement changes in current practices/protocols where possible
  • Maintains State of Connecticut Insurance Department Casualty License
  • Assists in overall vendor management process, including providing regular feedback on performance, and negotiating contract terms and conditions
  • Generates reports from TPA and legal counsel to audit data accuracy of our cases; ensure terminations occur; identify trends
  • Dives deeper to find root cause of claims in order to determine if trends are taking place or new practices/processes need to be implemented
  • Partners with Business operations in the reconciliation of financials - workers comp checks; payments; medical expenses; that are provided from the vendor and into the Risk Envision system in coordination with Clients RMIS systems

  • 10 years of experience adjusting or managing workers compensation claims - past employers could be Travelers, Sedgwick etc any TPA

Qualified applicants will receive consideration for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or genetic information. 


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