Claim Representative (Finance)
JOB DESCRIPTION
Chubb is currently seeking a Workers' Compensation Medical Only Claim Examiner for our West Coast/Pacific region. The successful applicant will be handling claims from California. The position will report and reside in our Los Angeles, CA office.
Duties & 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.
- Review and assess new medical-only claims to determine eligibility and coverage under workers' compensation policies and complete coverage match where necessary.
- Conducts initial and ongoing investigations, obtaining facts and takes statements as necessary, with insured, claimant and medical providers.
- Evaluates the facts gathered through the investigation to determine compensability of the claim or if additional investigation for AOE/COE investigation.
- Coordinate and authorize appropriate medical treatment for injured workers, ensuring timely and effective care.
- Sets timely 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, telephonic cases managers, and use all medical cost containment programs.
- 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.
- Works with in-house Technical Assistants, Special Investigators, Nurse to exceed customer's expectations for exceptional claims handling service.
- Always maintains 100%+ closing rate.
- Timely recommend transfer of claims to lost time status.
- Maintain detailed and accurate records of all claim activities, including medical reports, correspondence, and payment information.
- Serve as the primary point of contact for claimants, medical providers, and employers, providing updates and information as needed.
- Address and resolve any issues or disputes related to medical treatment or claim processing.
- Preference for prior experience as MO Claim Examiner in workers' compensation as a lost time examiner, or similar examiner experience in short-term / long-term disability, auto personal injury protection / medical injury, or general liability claims.
- Requires basic knowledge of workers' compensation statutes, regulations, and compliance. Understanding of workers' compensation laws and medical terminology.
- Exceptional customer service and focus.
- Ability to openly collaborate with leadership and peers to accomplish goals.
- Demonstrates a commitment to a career in claims.
- Exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines.
- Use analytical skills to find mutually beneficial solutions to claim and customer issues.
- Conscientious about the quality and professionalism of work product and relationships with co-workers and clients.
- Willing to take ownership and tackle obstacles to meet Chubb's quality
- standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
- Superior verbal and written communication skills.
- High school diploma or equivalent; some positions may require an associate's or bachelor's degree in a related field.
- Experience working in a customer focused, fast-paced, fluid environment
- Experience utilizing strong communication and telephonic skills
- Prior experience requiring a high level of organization, follow-up, and accountability
- Prior workers' compensation claim handling experience or other similar type of claim handling experience is preferred (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability).
- 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.
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.
