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Claims Analyst in New Haven, CT at CRS Group

Date Posted: 2/9/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    New Haven, CT
  • Job Type:
    Insurance
  • Experience:
    At least 10 year(s)
  • Date Posted:
    2/9/2018

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

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

 
 
 
 
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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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