Claim Representative

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.

Technical Skills & Competencies:


* 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 ...