Claims Examiner, WICA
1 month ago
The primary objective of this role is to manage TPA for Work Injury Compensation claims, resolving them within prescribed authority in the most effective and efficient way while delivering a customer-centric claims service.
Key Responsibilities:- Proactively manage claims to ensure timely resolution and customer satisfaction.
- Review and analyze policy coverage to ensure adequacy of reserve and conduct on-time file reviews.
- Evaluate and negotiate claim resolutions to achieve cost-effective outcomes.
- Identify potential fraud, risk management, and recovery opportunities.
- Manage client expectations both internally and externally.
- Take responsibility for ad-hoc projects and contribute to team goals.
- Work within local and regional operating processes and claim handling procedures to ensure quality claim service to all customers in accordance with Chubb Claims Philosophy.
- Attend to claim enquiries and feedback, maintaining positive relationships with customers, brokers, and service providers.
- Engage external resources in accordance with Chubb guidelines and philosophies, including service providers and case management.
- Manage and handle claims to finality within designated Settlement Authority and Chubb Claims Management Guidelines.
- Ensure timely updates of claims data and correctness of systems and file records.
- Comply with Chubb quality review program guidelines and take corrective action as necessary.
- Complete Reserve Reconciliation and Advocacy reviews in accordance with Chubb guidelines.
- Maximize recoveries from insurers, salvage dispositions, subrogation, or other recovery proceedings through close monitoring.
- Assist in claims-related projects, including UAT, and other projects/assignments or tasks as assigned.
- Meet or exceed individual and team yearly goal settings.
- Knowledge in WIC claims handling.
- Excellent communication and interpersonal skills, with the ability to manage internal and external stakeholders effectively.
- Excellent customer service skills.
- Ability to organize work effectively and methodically, with high adaptability to change in a fast-paced environment.
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