- Handles all aspects of workers' compensation medical only 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 three-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 medical treatment.
- Informs insureds and claimants of claim denials when applicable.
- Prepares reports on investigations, settlements, denials of claims, evaluations of involved parties, etc.
- Timely administration of statutory medical only benefits throughout the life of the claim.
- Sets reserves within authority limits for medical 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.
- Controls and directs vendors, nurse case managers, and telephonic case managers on medical management.
- Complies with customer service requests, including Special Claims Handling procedures and file status notes.
- Submits workers' compensation forms and electronic data to 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
- Entry-level Medical Only Claim Examiner position.
- Knowledge of insurance, claims, and workers' compensation statutes, regulations, and compliance is a plus, but on-the-job training will be provided to the chosen applicant.
- Ability to incorporate data analytics and modeling into daily activities to expedite the fair and equitable resolution of claims and claim issues.
- A personal commitment to superior performance that adds value to our company and our customers.
- Ability to work effectively with a wide variety of people.
- An aptitude for evaluating, analyzing, and interpreting information.
- Superior telephonic skills.
- Excellent organizational skills.
- The ability to multi-task with proven time management skills to meet deadlines.
- Ability to work well in teams.
- Demonstrate critical thinking and decision-making ability.
- Excellent verbal and written communication skills.
- Prior medical only or similar claim handling experience is a plus but not required.
- Proficiency in using Microsoft Office Products
- Experience in a fast-paced, fluid environment
- Strong communication and telephonic skills
- 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.
- Applicants will have 180 days from the date of hire to acquire the necessary licenses if selected for the position.
- Knowledge of medical terminology is a plus but not required.
- Knowledge of bill processing is a plus but not required.
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Workers' Compensation Medical Only Claim Examiner - New Haven, United States - Chubb
Description
Chubb is currently seeking a Workers' Compensation Medical Only 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.Duties & Responsibilities:
Technical Skills & Competencies:
Experience, Education, & Requirements:
