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Chubb · 3 weeks ago

Workers' Compensation Lost Time Senior Claim Examiner

New Haven, CT

Full-time

Onsite

Mid, Senior Level

4+ years exp

Chubb is a world leader in insurance, seeking a Workers’ Compensation Lost Time Senior Claim Examiner for their Northeast Region. The successful candidate will independently manage all aspects of workers’ compensation lost time claims, ensuring compliance and strong customer relations throughout the claims process.

Commercial InsuranceFinancial ServicesHealth InsuranceInsuranceMortgageRisk Management

Responsibilities

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

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 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

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 the Leadership Team to exceed customer's expectations for exceptional claims handling service

Qualification

Workers' compensation claimsData analyticsLitigation managementFraud investigationsMedical case managementMicrosoft Office proficiencyExceptional customer serviceTime managementVerbal communicationWritten communicationProject managementMentorshipCollaboration

Required

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 demonstrating 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 analyses to ensure adequacy and demonstrate financial acumen

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

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