Senior Claim Examiner-Workers Compensation

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 a Claim Manager 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
• Informs insureds, claimants and attorneys of claim denials when applicable
• Prepares reports on investigation, settlements, denials of claims and 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 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 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 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 :

Experience, Education & Requirements :