Claim Examiner
3 weeks ago
Claims Examiner
Our award-winning Claims Department has an exciting career opportunity for an individual who enjoys independent problem solving and utilization of their interpersonal and collaboration skills to build relationships with insureds, agents, and internal business partners.
Responsibilities
Duties may include, but are not limited to:
- Accurately evaluate and process claims based on relevant documentation.
- Evaluate claim submissions, determine policy benefits, and request additional information as required to finalize claims.
- Manage inquiries, escalations and pending files on claim decisions.
- Provide exceptional customer service by promptly following up and collaborating with internal and external business partners to address concerns and/or questions.
- Build broad knowledge of the various online systems for claims processing, imaging, and policy administration.
- Maintain appropriate documentation on all claim files and manage caseload in a timely manner while meeting quality standards and SLAs.
- Research, analyze, and interpret policy language and State law as it relates to submitted claims.
- Communicate and collaborate effectively with Adjusters, Supervisors, and Managers to ensure service levels are met daily.
- Recognize, prioritize, and escalate service and claims issues according to escalation guidelines.
- Support an environment of continuous improvement by offering ideas and suggestions to improve workflows and processes.
- Performs other duties as assigned.
Qualifications
- 5 - 7 years of auditing Accident and Health Claims processing, AD&D claim processing or claim investigation experience preferred.
- Experience in a customer interfacing position with progressive responsibility in role.
- Experience with case management process and ability to implement case management processes with clients.
- Understanding and ability to effectively manage PPO networks to ensure cost savings measures.
- Strong communication and writing abilities.
- Ability to interact with senior management both internally and with our external business partners.
- Bachelor's degree or proven insurance related experience.
- Proven track record handling all types of Accident & Health claims.
- Able to work under tight deadlines with limited oversight.
- Adjuster licenses in required jurisdictions within 90 days of employment. Failure to obtain the license within 90 days will result in termination of employment.
- Ability to work independently and assimilate learning materials on many different subjects from various sources.
- Ability to deal with customers in a professional manner.
- Ability to self-motivate and self-start.
- Ability to make independent decisions using Chubb best practices for guidance.
- Ability to effectively work in a team environment.
- Ability to multi-task.
- Strong interpersonal, negotiation, and customer service skills.
- Capable of dealing with highly visible and demanding customers.
- Highly organized and able to respond to insureds and internal and external business partners in a timely manner.
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.
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