Workers' Compensation Medical Claims Examiner

3 weeks ago

Alpharetta, United States Chubb Full time

Job Summary:

Chubb is seeking a Workers' Compensation Medical Claims Examiner to join our team in the Southeast Region. This role is based in our Alpharetta, Georgia office and offers a hybrid work arrangement, with three days in the office and two days remotely.

Key Responsibilities:

  • 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 investigation.
  • Conducts 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.
  • 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 case 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, and Team Supervisors to exceed customer expectations for exceptional claims handling service.

Requirements:

  • 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.
  • 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.

Education and Experience:

  • 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.

About Us:

Chubb is a world leader in insurance, providing commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. Our 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.

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