Worker's Compensation Lost Time Senior Claim Examiner - OneTen Coalition
Madison Center, MI
About the Job
JOB DESCRIPTION
Chubb is currently seeking a Workers' Compensation Lost Time Claim Specialist 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 a Claim Manager and reside in either our New Haven, Connecticut.
- 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 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.
- Informs insureds, claimants, and attorneys of claim denials when applicable.
- Prepares reports on investigation, settlements, denials of claims and 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 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.
- 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.
- Complies 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 Team Supervisors to exceed customer's expectations for exceptional claims handling service.
QUALIFICATIONS
- 3 - 5 years of prior Workers' Compensation Lost Time claim handling experience
- 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
- 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
ABOUT US
Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.
At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.
Chubb is currently seeking a Workers' Compensation Lost Time Claim Specialist 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 a Claim Manager and reside in either our New Haven, Connecticut.
- 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 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.
- Informs insureds, claimants, and attorneys of claim denials when applicable.
- Prepares reports on investigation, settlements, denials of claims and 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 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.
- 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.
- Complies 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 Team Supervisors to exceed customer's expectations for exceptional claims handling service.
QUALIFICATIONS
- 3 - 5 years of prior Workers' Compensation Lost Time claim handling experience
- 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
- 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
ABOUT US
Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.
At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.
Source : OneTen Coalition