Claim Examiner

JOB DESCRIPTION

Chubb is currently seeking a Workers' Compensation Lost Time Senior 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 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 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 claim.


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


* Prepares reports on investigation, settlements, denials of claims and 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 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.


* Works with attorneys to manage hearings and litigation


* Controls and directs vendors, nurse case managers, telephonic cases 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.


* 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:


* Lost Time Claim Examiner position with prior experience 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.


* 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 lea...