Claims Examiner (Medical Only)
CHUBBGA, United States30+ days ago
Job descriptionEntry-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. Bachelor's Degree preferred but not required Prior medical only or similar claim handling experience is a plus but not required Proficiency with Microsoft Office Products Experience in a fast paced, fluid environment Strong 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 required Knowledge of bill processing is a plus but not required
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 :
Experience, Education & Requirements :