Claim Representative

Workers' Compensation Medical Only Claim Examiner

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 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 claim and customer issues.
• Conscientious about the quality and professionalism of work product and relationships with co-workers and clients.
• Willing to take ownership and tackle obstacles to meet Chubb's quality standards for service, investigation, reserving, inventory management, teamwork, and diversity appreciation.
• Superior verbal and written communication skills.
• High school diploma or equivalent; some positions may require an associate's or bachelor's degree in a related field.

Experience, Education & Requirements:

• Experience working in a customer focused, fast-paced, fluid environment
• Experience utilizing strong communication and telephonic skills
• Prior experience requiring a high level of organization, follow-up, and accountability
• Prior workers' compensation claim handling experience or other similar type of claim handling experience is preferred (healthcare, short-term / long-term disability, auto personal injury protection / medical injury, or general liability).
• 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.

The pay range for the role is $57,200 to $80,300. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.