Workers' Compensation Medical Only Claim Representative

Chubb is currently seeking a Workers Compensation Medical Only Claim Representative 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:

• 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.
• Inform 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
  Consultants Telephonic Case Managers and Team Supervisors to exceed customers expectations for exceptional claim handling service.

Technical Skills & Competencies:

• 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.

Experience Education & Requirements:

• 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 medical billing 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 (all casualty lines) New Hampshire (workers compensation) Rhode Island (workers compensation) and Vermont (workers compensation) are required.
• 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.