- 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 the investigation.
- Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with the insured, claimant, and medical providers.
- Evaluates the facts gathered through the investigation to determine the compensability of the claim.
- Informs insureds, claimants, and attorneys of claim denials when applicable.
- Prepares reports on investigation, settlements, denials of claims, 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 case 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.
- File 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, and nurses
Consultants, telephonic case managers, and Team Supervisors to exceed customer's expectations for exceptional claims handling service. - Lost Time Claim Examiner position with prior experience in workers' compensation as a medical only examiner or similar examiner experience in 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 the fair and equitable resolution of claims and claim issues.
- Exceptional customer service and focus.
- Ability to openly collaborate with leadership and peers to accomplish goals.
- Demonstrates a commitment to a career in claims.
- Exceptional time management and multi-tasking capabilities with consistent follow-through to meet deadlines.
- Use analytical skills to find mutually beneficial solutions to claims and customer issues.
- Ability to prepare and make exceptional presentations to internal and external customers.
- Conscientious about the quality and professionalism of work product and
relationships with co-workers and clients. - Willing to take ownership and tackle obstacles to meet Chubb's quality
standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation. - Superior verbal and written communication skills.
- Experience working in a customer-focused, fast-paced, fluid environment
- 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.
- Proficiency with Microsoft Office Products
- 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.
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Workers' Compensation Lost Time Claim Examiner - New Haven, United States - CHUBB
Description
Chubb is currently seeking a Workers' Compensation Lost Time Claim Examiner for our Northeast, New York, and New Jersey Region. The successful applicant will be handling claims from Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, and New Jersey. The position will report to and reside in our New Haven, Connecticut, office on a 3/2 Hybrid work model.
Technical Skills & Competencies:
Experience, Education , & Requirements:
