Worker's Compensation, Medical Only Claim Examiner

JOB DESCRIPTION

Workers' Compensation Medical Only Claim Examiner

Chubb is the world's largest publicly traded property and casualty insurer.

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.

Chubb is currently seeking a Workers' Compensation Medical Only Claim Examiner for our West Region.

The successful applicant will be handling claims from California, Arizona, Colorado, and Utah.

The position will report and reside in our Los Angeles 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.


* 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...