Claim Representative
Claim Representative
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Chubb is currently seeking a Workers Compensation Medical Only Claim Examiner for our Central Region. The successful applicant will be responsible for managing all aspects of Medical Only claims arising from various states including Illinois Iowa Michigan Minnesota and Texas. This position is an onsite role located in Chicago IL.
Duties & Responsibilities
- Handles all aspects of workers compensation medical only 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 threepart (insureds claimants and medical providers) investigations obtaining facts and taking statements as necessary.
- Evaluates the facts gathered through the investigation to determine the compensability and relatedness of the medical treatment.
- Adhere to state regulations for assigned states.
- Adhere to Best Practice guidelines.
- 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 Supervisor throughout the life of the claim.
- Reviews the claim status at regular intervals and makes recommendations to Supervisor to discuss problems and remedial actions to resolve them.
- Controls and directs vendors 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.
Technical Skills & Competencies
- Entrylevel Medical Only Claim Examiner position.
- Knowledge of insurance claims and workers compensation statutes regulations and compliance is a plus but onthejob 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 and in a team environment.
- An aptitude for evaluating analyzing and interpreting information.
- Superior customer service showcasing verbal written and interpersonal skills.
- Excellent organizational and time management skills which demonstrate the ability to multitask and prioritize by accomplishing a high volume of tasks and assignments within defined deadlines.
- Adaptability to constantly evolving environments and demonstrable flexibility which meets or exceeds state requirements or customers expectations.
Experience Education & Requirements
- College degree in any area of study is preferred but not required.
- Prior workers compensation medical only or similar claim handling experience is a plus but not required.
- Knowledge of medical terminology is a plus but not required.
- Knowledge of bill processing is a plus but not required.
- Proficient computer skills and extensive knowledge of the Microsoft suite of Office products including Outlook Word Excel and PowerPoint.
- Experience in a fastpaced fluid environment
- 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.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
