Workers' Compensation Lost Time Senior Claim Examiner

Chubb is currently seeking a Workers’ Compensation Lost Time Senior Claim Examiner for our Northeast, New York, and New Jersey region.

The successful applicant will be handling claims from Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, and New Jersey.

The position will reside in our office located in New Haven, Connecticut.

Duties & Responsibilities :

Independently handles all aspects of workers’ compensation lost time 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 3-part ongoing investigations, obtaining facts and taking statements as necessary, with the insured, claimant, and medical providers

Evaluates the facts gathered through the investigation to determine the compensability of the claim

Informs insureds, claimants, and attorneys of claim denials when applicable

Prepares reports on investigation, settlements, denials of claims, evaluations of involved parties, etc.

Timely administration of statutory medical and indemnity benefits throughout the life of the claim

Sets reserves within authority limits for medical, indemnity, and expenses and recommends reserve changes to the team leader throughout the life of the claim

Reviews the claim status at regular intervals and makes recommendations to the team leader to discuss problems and remedial actions to resolve them

Prepares and submits to the team leader unusual or possible undesirable exposures when encountered

Works with attorneys to manage hearings and litigation

Controls and directs vendors, nurse case managers, telephonic case managers, and rehabilitation managers on medical management and return-to-work initiatives

Complies with customer service requests, including special claims handling procedures, file status notes, and claim reviews

Timely administration and filing of all electronic data and workers’ compensation forms 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, and Nurse

Consultants, Telephonic Case Managers, and Team supervisors

Must exceed customer's expectations for exceptional claim handling service

Technical Skills & Competencies :

Prior experience in workers’ compensation as a lost time claim examiner or medical only examiner.

Alternately, potential candidates should possess and be prepared to demonstrate transferable skills from other claim roles including short-term / long-term disability, auto personal injury protection, auto liability, medical injury, general liability, or other related customer service fields

Works with a high degree of autonomy and showcases venue expertise

Requires knowledge of workers’ compensation statutes, regulations, and compliance

Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues

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 claims and customer issues.

Ability to prepare and make exceptional presentations to internal and external customers

Conscientious about the quality and professionalism of work product and

relationships with co-workers and clients

Willing to take ownership and resolve issues to meet Chubb's quality

standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation

Superior verbal and written communication skills

Experience, Education

& Requirements :

4 - 6 years of prior claim experience, or related field, with a preference for workers’ compensation claims

Experience working in a customer-focused, fast-paced, fluid environment

Experience utilizing strong communication and telephonic skills

Prior experience demonstrating a high level of organization, follow-up, and accountability

AIC, RMA, or CPCU-completed coursework or designation(s) is a plus but not required

Experience with litigation management

Experience with subrogation investigations

Experience with fraud investigations

Experience with medical case management

Knowledge of medical terminology, treatment and related costs

Knowledge of medical ICD coding and Medicare standards

Conduct reserve analyses to ensure adequacy and demonstrate financial acumen

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.

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.