Claim Representative
3 weeks ago
JOB DESCRIPTION Chubb is currently seeking a Workers' Compensation Medical Only Claim Examiner for our Central Region. The successful applicant will be responsible for managing all aspects of Medical Only claims arising from various states including Illinois, Iowa, Michigan, Minnesota, and Texas. This position offers a hybrid work schedule with a minimum of 3 days per week working from either our Dallas or Chicago Office. Handles all aspects of workers' compensation medical only 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 three-part (insureds, claimants, and medical providers) investigations, obtaining facts and taking statements as necessary. Evaluates the facts gathered through the investigation to determine the compensability and relatedness of the medical treatment. Adhere to state regulations for assigned states. Adhere to Best Practice guidelines. Prepares reports on investigations, settlements, denials of claims, evaluations of involved parties, etc. Timely administration of statutory medical only benefits throughout the life of the claim. Sets reserves within authority limits for medical and expenses and recommends reserve changes to Supervisor throughout the life of the claim. Reviews the claim status at regular intervals and makes recommendations to Supervisor to discuss problems and remedial actions to resolve them. Controls and directs vendors and telephonic case managers on medical management. Complies with customer service requests, including Special Claims Handling procedures and file status notes. Submits workers' compensation forms and electronic data to states to ensure compliance with statutory regulations. Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized. Technical Skills and Competencies Entry-level Medical Only Claim Examiner position. Knowledge of insurance, claims, and workers' compensation statutes, regulations, and compliance is a plus, but on-the-job training will be provided to the chosen applicant. Ability to incorporate data analytics and modeling into daily activities to expedite the fair and equitable resolution of claims and claim issues. A personal commitment to superior performance that adds value to our company and our customers. Ability to work effectively with a wide variety of people and in a team environment. An aptitude for evaluating, analyzing, and interpreting information. Superior customer service showcasing verbal, written, and interpersonal skills. Excellent organizational and time management skills which demonstrate the ability to multi-task and prioritize by accomplishing a high volume of tasks and assignments within defined deadlines. Adaptability to constantly evolving environments and demonstrable flexibility which meets or exceeds state requirements or customer's expectations. College degree in any area of study is preferred but not required. Prior workers' compensation medical only or similar claim handling experience is a plus but not required. Knowledge of medical terminology is a plus but not required. Knowledge of bill processing is a plus but not required. Proficient computer skills and extensive knowledge of the Microsoft suite of Office products including Outlook, Word, Excel, and PowerPoint. Experience in a fast-paced, fluid environment 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. ABOUT US Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, p rsonal 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. Equal Opportunity Employer - minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity
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