A&H Claims Examiner (12M Ftc)

Chubb North Scituate , MA 02060

Posted 2 weeks ago

Role Purpose:

The primary purpose of this role is to produce a high quality work product on Accident & Health or Combined Insurance claims through prompt and professional contact with customers and brokers and through the effective investigation, reserving and adjustment of claims incurred by insureds.

Responsibilities:

The duties and responsibilities of the role may alter over time due to changing needs of the business or changes in procedures or IT. Currently they include:

  • Manage a portfolio of claims for Accident & Health and /or Combined Insurance claims as allocated and assist processing other Retail claims as required.

  • Assess claims in accordance with Chubb's service level and quality requirements and the General Insurance Code of Practice. This includes determining coverage, reserving within timeframes, making payments, responding to customer queries, providing updates, and requesting additional information as needed to manage a claim.

  • Communication by telephone and written correspondence to brokers, claimants and others as required.

  • Take part in Claim Department and companywide training as required.

  • Respond to enquiries and escalations of matters from underwriters, brokers and customers, and work with underwriters, the Compliance Department and other departments of the company as needed.

  • Proactively apply claims policies and procedures including Chubb's policy in relation fraud, salvage, cost containment and complaints.

  • Where applicable, review income replacement claims for payment of periodic benefits at lodgement stage and at key points in the claim cycle and develop strategies for claim management and successful return to work of the claimant where possible.

  • Participate in claims meetings with internal and external stakeholders as required.

  • Manage Emergency Assistance cases end to end as allocated.

  • Facilitate payment of claims costs and service provider fees including reconciliation and liaison with Chubb's Shared Services Unit overseas and the service providers.

  • Provide advice, instructions and coaching to Chubb's Shared Services Unit overseas and outsourced service providers as required on claims within delegated authority limit.

  • Monitor performance and processes of service providers to make recommendations in respect of process and contract compliance, escalating breaches to Claims Management.

  • Assist in daily payment, audit, and other administrative tasks as required.

  • General assistance within the Claims Department and adoption of other duties in response to altered business needs and staff changes.

Experience & Skills Required:

  • Tertiary Qualified or minimum 2-5 years similar work experience

  • Investigation techniques.

  • Written and verbal communication related to claims handling.

  • Insurance contracts

  • Legal requirements and regulations.

  • Damage and/or loss evaluation.

  • Negotiation skills.

  • Litigation procedures.

  • Reserving skills.

  • Chubb claim philosophy.

  • Capable of participating in audits

  • 1st and/or 3rd party fraud (desirable)

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A&H Claims Examiner (12M Ftc)

Chubb