Lost Time Senior Claim Examiner
Lost Time Senior Claim Examiner
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Salary Not Disclosed
1 Vacancy
Job Description
Chubb is currently seeking a Workers Compensation Lost Time Senior 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 reside in our office located in New Haven Connecticut.
Duties & Responsibilities:
- Independently handles all aspects of workers compensation lost time claims from setup to case closure ensuring strong customer relations are maintained throughout the process
- Reviews claim and policy information to provide background for the investigation
- Conducts 3part 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 the team leader throughout the life of the claim
- Reviews the claim status at regular intervals and makes recommendations to the team leader to discuss problems and remedial actions to resolve them
- Prepares and submits to the 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 returntowork initiatives
- Complies with customer service requests including special claims handling procedures file status notes and claim reviews
- Timely administration and filing of all electronic data and workers compensation forms 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 inhouse Technical Assistants Special Investigators and Nurse
Consultants Telephonic Case Managers and Team supervisors - Must exceed customers expectations for exceptional claim handling service
Technical Skills & Competencies:
- Prior experience in workers compensation as a lost time claim examiner or medical only examiner. Alternately potential candidates should possess and be prepared to demonstrate transferable skills from other claim roles including shortterm / longterm disability auto personal injury protection auto liability medical injury general liability or other related customer service fields
- Works with a high degree of autonomy and showcases venue expertise
- Requires knowledge of workers compensation statutes regulations and compliance
- Ability to incorporate data analytics and modeling into daily activities to expedite 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 multitasking capabilities with consistent followthrough 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 coworkers and clients - Willing to take ownership and resolve issues to meet Chubbs quality
standards for service investigation reserving inventory management teamwork and diversity appreciation - Superior verbal and written communication skills
Experience Education & Requirements:
- 4 6 years of prior claim experience or related field with a preference for workers compensation claims
- Experience working in a customerfocused fastpaced fluid environment
- Experience utilizing strong communication and telephonic skills
- Prior experience demonstrating a high level of organization followup and accountability
- AIC RMA or CPCUcompleted coursework or designation(s) is a plus but not required
- Experience with litigation management
- Experience with subrogation investigations
- Experience with fraud investigations
- Experience with medical case management
- Knowledge of medical terminology treatment and related costs
- Knowledge of medical ICD coding and Medicare standards
- Conduct reserve analyses to ensure adequacy and demonstrate financial acumen
- 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.
- Proficiency with Microsoft Office Products
Required Experience:
Senior IC
Employment Type
Full Time
