Workers Compensation - Lost Time Claim Examiner

JOB DESCRIPTION

Chubb is currently seeking a Workers' Compensation Lost Time 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 report to and reside in our New Haven, Connecticut, 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 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 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 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.


* File 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, and nurses
Consultants, telephonic case managers, and 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 medical only examiner or similar examiner experience in short-term / long-term disability, auto personal injury protection, medical injury, general liability, or as a claim technical assistant for lost time claims.


* Requires knowledge of workers' compensation statutes, regulations, and compliance.


* Ability to incorporate data analytics and modeling into daily activities to exped...