Workers' Compensation Lost Time Claim Examiner

Chubb is seeking a Workers' Compensation Lost Time Claim Examiner for our Northeast, New York, and New Jersey Region. The successful applicant will handle claims from Vermont, New Hampshire, Massachusetts, Rhode Island, Connecticut, New York, and New Jersey. This position reports to and is based in our New Haven, Connecticut office.

About the role

Handles all aspects of workers' compensation lost time claims from initial set-up to case closure, ensuring strong customer relations are maintained throughout the process.

Responsibilities

• 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 compensation for 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.
• Administers statutory medical and indemnity benefits in a timely manner throughout the life of the claim.
• Sets reserves within authority limits for medical, indemnity, and expenses; recommends reserve changes to Team Leader throughout the life of the claim.
• Reviews claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions.
• Prepares and submits unusual or possible undesirable exposures to Team Leader 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.
• 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 maximize recovery opportunities.
• Collaborates with in-house Technical Assistants, Special Investigators, nurses, Consultants, telephonic case managers, and Team Supervisors to exceed customer expectations for exceptional claims handling service.

Requirements

• Prior experience as a Lost Time Claim Examiner in workers' compensation is preferred but not required; training will be provided for candidates with strong technical backgrounds in other claim lines or complementary skillsets.
• 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 focus and ability to collaborate openly with leadership and peers.
• Commitment to a career in claims with strong time management and multi-tasking capabilities.
• Analytical skills to find mutually beneficial solutions to claims and customer issues.
• Ability to prepare and deliver exceptional presentations to internal and external customers.
• Proficiency with Microsoft Office Products.
• Claim adjuster licenses in Connecticut (all casualty lines), New Hampshire (workers' compensation), Rhode Island (workers' compensation), and Vermont (workers' compensation) are required. If not currently licensed, the applicant will have 3 attempts or 3 months from the date of hire, whichever is sooner, to acquire the necessary licenses.

Qualifications

• Experience working in a customer-focused, fast-paced, fluid environment.
• Strong communication and telephonic skills.
• High level of organization, follow-up, and accountability.
• Familiarity with claim handling (healthcare, short-term/long-term disability, auto personal injury protection, medical injury, or general liability) is a plus.
• Prior insurance, medical billing, legal, or corporate business experience is a plus.
• AIC, RMA, or CPCU-completed coursework or designation(s) is a plus.
• Knowledge of medical terminology and bill processing is a plus.

About Us

Chubb is a world leader in insurance, with operations in 54 countries. We provide 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, and superior claims handling expertise.