Senior Claim Examiner

Chubb - New Haven, CT

Full-time - Mid Level

New Haven, CT

Insurance Carriers and Related Activities

About the position

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.

Responsibilities

• Independently 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 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 return-to-work 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 in-house Technical Assistants, Special Investigators, and Nurse Consultants, Telephonic Case Managers, and Team supervisors
• Must exceed customer's expectations for exceptional claim handling service

Requirements

• 4 - 6 years of prior claim experience, or related field, with a preference for workers' compensation claims
• Experience working in a customer-focused, fast-paced, fluid environment
• Experience utilizing strong communication and telephonic skills
• Prior experience demonstrating a high level of organization, follow-up, and accountability
• AIC, RMA, or CPCU-completed 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

Nice-to-haves

• Prior experience in workers' compensation as a lost time claim examiner or medical only examiner
• 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 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 resolve issues to meet Chubb's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation
• Superior verbal and written communication skills