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Claims Examiner, WICA
1 month ago
The primary objective of this role is to effectively manage TPA for Work Injury Compensation claims, ensuring timely and cost-effective resolution while delivering exceptional customer-centric claims service.
Key Responsibilities:- Proactively manage claims to ensure efficient resolution within prescribed authority.
- Review and analyze policy coverage to ensure accurate claims handling.
- Ensure adequacy of reserves, conduct timely file reviews, and resolve claims effectively.
- Evaluate and negotiate claim resolutions to achieve cost-effective outcomes.
- Identify potential fraud, risk management, and recovery opportunities.
- Manage client expectations, both internal and external, to maintain positive relationships.
- 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, service providers, etc.
- Use external resources in accordance with Chubb guidelines and philosophies, engaging appropriate service providers where required, and managing cases towards timely and effective resolution.
- Manage and handle claims to finality within designated Settlement Authority and Chubb Claims Management Guidelines, including timely action, appropriate investigation, regular case reviews, and proper evaluation.
- Ensure loss reserves are set and maintained in accordance with Chubb guidelines, with timely updates of claims data into systems and correctness of systems and file records.
- Comply with Chubb quality review program guidelines and ensure corrective action is taken 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, ensuring timely advices, relevant supporting documents, and responses to enquiries are provided to coinsurers/reinsurers to settle their share promptly.
- Assist in claims-related projects, including UAT, and other projects/assignments or tasks, as assigned.
- Meet or exceed the expectations/objectives set on the individual's and the Team's yearly goal setting.
Skills and Experience:
- Knowledge in WIC claims handling.
- Excellent communication and interpersonal skills, with the ability to effectively manage all internal and external stakeholders.
- Excellent customer service.
- Ability to organize work effectively and methodically, with high adaptability to change in a fast-paced environment.
Ability to support the team claim handlers as required.