Workers' Compensation Senior Lost Time Claim Examiner

Workers' Compensation Lost Time Senior Claim Examiner

Chubb is currently seeking a Workers' Compensation Lost Time Senior 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:

• Requires minimal oversight to independently handle 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
• Inform insureds, claimants and attorneys of claim denials when applicable
• Prepare reports on investigation, settlements, denials of claims and evaluations of parties involved, 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 the Leadership Team throughout the life of the claim
• Reviews the claim status at regular intervals and makes recommendations to the Leadership Team to discuss problems and remedial actions to resolve them
• Prepares and submits to Leadership Team 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
• Comply 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 the Leadership Team to exceed customer's expectations for exceptional claims handling service

Technical Skills & Competencies:

• Understands day-to-day responsibilities of a Lost Time Claim Examiner in managing all aspects of workers' compensation claims
• Works with a high degree of autonomy and showcases venue expertise
• Serves as a mentor and informal leader to staff with less seniority
• Utilizes influence management skills to drive results, consistency amongst peers and as motivation
• Provides project management
• Serves as a subject matter expert
• Requires 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 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
• Ability to prepare and make exceptional presentations to internal and external customers
• Conscientious about the quality and professionalism of work product and relationships with co-workers and clients
• 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

Experience, Education & Requirements:

• 4+ years of direct handling claims for workers' compensation lost time claims
• Experience working in a customer focused, fast-paced, fluid environment
• Experience utilizing strong communication and telephonic skills
• Prior experience demonstrates a high level of organization, follow-up and accountability
• AIC, RMA, or CPCU completed coursework or designation(s) is a plus but not required
• Experience with litigation management
• Experience with subrogation investigations
• Experience with fraud investigations
• Experience with medical case management
• Knowledge of medical terminology
• Conduct reserve analysis to ensure adequacy and demonstrate financial acumen
• Claim adjuster licenses in Connecticut (all casualty lines), New Hampshire (workers' compensation), Rhode Island (workers' compensation), and Vermont (workers' compensation) are required. If any applicant does not have the required licenses, in current standing, the applicant will have three (3) attempts or three (3) months, whichever is sooner, from the date-of-hire, to acquire the necessary licenses.
• Proficiency with Microsoft Office Products