Workers' Compensation Senior Lost Time Claim Examiner

Chubb•New Haven, CT

3d•Onsite

About The Position

Chubb is seeking a Workers’ Compensation Lost Time Senior Claim Examiner for its Northeast, New York, and New Jersey Region. The successful applicant will handle 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. This role requires minimal oversight to independently handle all aspects of workers’ compensation lost time claims from set-up to case closure, ensuring strong customer relations are maintained throughout the process. The examiner will review claim and policy information, conduct investigations, evaluate facts to determine compensability, and administer statutory benefits. Responsibilities also include setting reserves, managing litigation with attorneys, directing vendors, and ensuring compliance with state regulations. The role involves referring claims to subrogation and collaborating with internal teams to exceed customer expectations.

Requirements

4+ years of direct handling claims for workers’ compensation lost time claims
Experience working in a customer focused, fast-paced, fluid environment
Experience utilizing strong communication and telephonic skills
Prior experience demonstrates a high level of organization, follow-up and accountability
Experience with litigation management
Experience with subrogation investigations
Experience with fraud investigations
Experience with medical case management
Knowledge of medical terminology
Conduct reserve analysis to ensure adequacy and demonstrate financial acumen
Claim adjuster licenses in Connecticut (all casualty lines), New Hampshire (workers’ compensation), Rhode Island (workers’ compensation), and Vermont (workers’ compensation) are required. If any applicant does not have the required licenses, in current standing, the applicant will have three (3) attempts or three (3) months, whichever is sooner, from the date-of-hire, to acquire the necessary licenses.
Proficiency with Microsoft Office Products
Understands day-to-day responsibilities of a Lost Time Claim Examiner in managing all aspects of workers’ compensation claims
Works with a high degree of autonomy and showcases venue expertise
Serves as a mentor and informal leader to staff with less seniority
Utilizes influence management skills to drive results, consistency amongst peers and as motivation
Provides project management
Serves as a subject matter expert
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 multi-tasking capabilities with consistent follow-through to meet deadlines
Use analytical skills to find mutually beneficial solutions to claim 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
Take ownership and tackle obstacles to meet Chubb's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation
Superior verbal and written communication skills

Nice To Haves

AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required

Responsibilities

Independently handle 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 investigation
Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and medical providers
Evaluates the facts gathered through the investigation to determine compensability of the claim
Inform insureds, claimants and attorneys of claim denials when applicable
Prepare reports on investigation, settlements, denials of claims and evaluations of parties involved, 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 Leadership Team throughout the life of the claim
Reviews the claim status at regular intervals and makes recommendations to the Leadership Team to discuss problems and remedial actions to resolve them
Prepares and submits to Leadership Team unusual or possible undesirable exposures when encountered
Works with attorneys to manage hearings and litigation
Controls and directs vendors, nurse case managers, telephonic cases managers and rehabilitation managers on medical management and return to work initiatives
Comply with customer service requests including Special Claims Handling procedures, file status notes, and claim reviews
Files workers’ compensation forms and electronic data 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, Nurse Consultants, Telephonic Case Managers as well as the Leadership Team to exceed customer's expectations for exceptional claims handling service