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Work Comp Claims Medical Only Examiner at Chubb

Posted in General Business 30+ days ago.

Type: Full-Time
Location: Los Angeles, California





Job Description:





Description:  
Chubb is the world’s largest publicly traded property and casualty insurer. With operations in 54 countries, Chubb provides 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, superior claims handling expertise and local operations globally. 


 

Job Summary/Duties:
A Workers Compensation Medical Only Claims Examiner handles approx. 250 non-litigated, no lost time cases made up of Medical Only and Fastrack files. A MO Examiner is responsible for all aspects of claim handling including initial employer, employee and medical provider contacts and investigations, if necessary per Chubb’s Best Practice Guidelines.
 
Duties also include medical benefit administration such as communicating with providers to confirm WC causation, requesting timely physician reports, confirming appropriateness of care per state guidelines and UR workflow and approving medical bills for payment timely and appropriately.
 
A Medical Only Examiner is also required to estimate and enter accurate reserves, to diary files for timely closure and to transfer files to a Lost Time Examiner as soon as potential lost time or litigation occurs. Most Medical Only files are handled per CA WC regulation with approx. 10-15% handled under AZ, CO and UT state requirements.     
 
Medical Only Claim Examiner will be expected to


  • Demonstrate effective time management skills to handle 50-60 new losses per month with Fastrack files requiring less Examiner activity

  • Use Diary management techniques and Chubb 4D to establish Action Plans and due dates to process and close files promptly   

  • Conduct and collaborate with SIU and Supervisor to investigate compensability, fraud and subrogation timely and appropriately

  • Manage and collaborate with TCM, NC, UR and Supervisor to ensure medical treatment is provided timely and appropriately

  • Handle Sport Claims and refer some cases to legal counsel to file a Motion for Closure if there is no response to medical treatment

  • Make appropriate compensability and reserve decisions within their authority

  • Meet each state’s compliance requirements for timely EDI and notice/form filing

  • Demonstrate timely exposure recognition to escalate issues and transfer files as needed

  • Request timely notices and utilize the correct templates for the various jurisdictions

  • Document file status, reserves and plans of action in thorough WC Status Notes

  • Use proactive communication skills to provide customers with an exceptional service experience.  

 
Job Qualifications

  • Strong organizational, prioritization, time management and computer skills

  • Strong communication skills that fosters continuous learning and team collaboration

  • Written, oral and presentation skills that are effective with a variety of customers

  • Understanding of insurance fundamentals: claims, underwriting, agency relationships, and the business impact of accurate payments, coding and reserves

 


Chubb strives to offer a diverse and inclusive and rewarding work environment. Teamwork and mutual respect are central to how Chubb operates and we believe the best solutions draw upon diverse perspectives, experiences and skills. We operate in such a way where everyone, regardless of their singular background has the opportunity to contribute to our collective success.





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