Workers’ Compensation Medical Only Claim Examiner

Join Chubb as an Entry-level Workers Compensation Medical Only Claims Examiner in our Southeast Region! This role, based in our Alpharetta, Georgia office, offers a hybrid work arrangement—three days in the office and two days remotely.

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. 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 medical treatment. Informs insureds and claimants of claim denials when applicable. Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc. Timely administration of statutory medical only benefits throughout the life of the claim.  Sets 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, nurse case managers, telephonic cases managers on medical management.   Complies with customer service requests including Special Claims Handling procedures and file status notes. 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 Team Supervisors to exceed customer's expectations for exceptional claims handling service.

 

Technical Skills & Competencies:

Entry-level Medical Only Claim Examiner position. Knowledge of insurance, claims, and workers’ compensation statutes, regulations and compliance are a plus, but on-the-job training will be provided to chosen applicant.  Ability to incorporate data analytics and modeling into daily activities to expedite fair and equitable resolution of claims and claim issues. A personal commitment to superior performance that adds value to our company and our customers. An ability to work effectively with a wide variety of people. An aptitude for evaluating, analyzing, and interpreting information. Superior telephonic skills. Excellent organizational skills. The ability to multi-task with proven time management skills to meet deadlines. An ability to work well in teams. Demonstrate critical thinking and decision-making ability. Excellent verbal and written communication skills.

 

Experience, Education & Requirements:

Bachelor's Degree preferred but not requiredPrior medical only or similar claim handling experience is a plus but not requiredProficiency with Microsoft Office ProductsExperience in a fast paced, fluid environmentStrong communication and telephonic skills Claim Adjuster license in Georgia preferred; however, not required at the time of posting for the position. Knowledge of medical terminology is a plus but not requiredKnowledge of bill processing is a plus but not required