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Workers' Compensation Medical Claims Examiner
4 weeks ago
As a Workers' Compensation Medical Only Claims Examiner at Chubb, you will be responsible for handling all aspects of workers' compensation medical only claims from set-up to case closure, ensuring strong customer relations are maintained throughout the process.
### Key Responsibilities
* Handles all aspects of workers' compensation medical only claims from set-up to case closure
* 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 medical treatment
* Informs insureds and claimants of claim denials when applicable
* Prepares reports on investigation, settlements, denials of claims and 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 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
* Controls and directs vendors, nurse case managers, telephonic cases managers on medical management
* Complies with customer service requests including Special Claims Handling procedures and file status notes
* 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.
### Technical Skills & Competencies
* Entry-level Medical Only Claim Examiner position
* Knowledge of insurance, claims, and workers' compensation statutes, regulations and compliance are a plus, but on-the-job training will be provided to chosen applicant
* Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues
* Personal commitment to superior performance that adds value to our company and our customers
* Ability to work effectively with a wide variety of people
* Aptitude for evaluating, analyzing, and interpreting information
* Superior telephonic skills
* Excellent organizational skills
* Ability to multi-task with proven time management skills to meet deadlines
* Ability to work well in teams
* Demonstrate critical thinking and decision-making ability
* Excellent verbal and written communication skills
### Experience, Education & Requirements
* Bachelor's Degree preferred but not required
* Prior medical only or similar claim handling experience is a plus but not required
* Proficiency with Microsoft Office Products
* Experience in a fast paced, fluid environment
* Strong communication and telephonic skills
* Claim Adjuster license in Georgia preferred; however, not required at the time of posting for the position
* Knowledge of medical terminology is a plus but not required
* Knowledge of bill processing is a plus but not required
