Summary: This role involves the comprehensive administration, validation, and reconciliation of Third-Party Administrator (TPA) claims within Chubb's claims systems. The Claims Examiner acts as a liaison among TPAs, claimants, brokers, and internal teams to ensure claims data accuracy and facilitate timely settlements. Strong analytical and organizational skills are essential for resolving claims issues and maintaining compliance with policies and regulations. The position also supports process improvements and team training to enhance operational excellence in claims management.
Key Responsibilities:
- Enter, verify, validate, and analyze TPA claim data (new claims, reopening, reserve changes, payments, recoveries, closures) in the Claim Vision system
- Review and assess complex claims end-to-end, including settlement, responding to customer queries, providing updates, and requesting additional information
- Investigate and evaluate complex claims, applying technical knowledge to determine appropriate settlement amounts in accordance with policy terms and conditions
- Communicate regularly with TPAs, oversight teams, TPA Management, claimants, and brokers to ensure funding accuracy, resolve discrepancies, and provide updates
- Manage negotiations with claimants and brokers regarding claims decisions and settlement amounts
- Prepare and send written correspondence (requests for information, settlements, etc.) to brokers, claimants, and other stakeholders
- Ensure loss reserves are set and maintained with timely updates of claims data, ensuring correctness of systems and file records
- Proactively apply claims policies and procedures, including fraud, salvage, recovery, cost containment, and complaints
- Attend to claims enquiries and feedback, maintaining positive relationships with customers, brokers, providers, and other stakeholders
- Immediately report potentially and confirmed fraudulent cases, compliance, and privacy breaches to management
- Attend administrative activities (team huddles, trainings)
- Perform other related duties as assigned by supervisors
Key Skills:
- Minimum 3-4 years of similar work experience
- Claims insurance background required
- Excellent analytical skills and strong attention to detail
- Sound knowledge of claims administration procedures and related systems
- Demonstrated strong communication skills (written and verbal) and interpersonal skills for dealing with all levels of Chubb personnel, claimants, and brokers
- Ability to organize work effectively, methodically, and as part of a team
- Adaptability to change driven by business needs
- Ability to multitask, manage workload efficiently, and consistently meet deadlines
- Quality & Customer Service
- Ability to maintain a high level of quality in all claims administration activities, ensuring settlement times and complaint levels are minimized
- Strong investigation techniques and customer service behavior
- Problem-solving skills to quickly identify issues, implement solutions, or escalate to management
- Exercise sound judgment in processing claims, especially when system requirements vary by payment type
Salary (Rate): undetermined
City: undetermined
Country: undetermined
Working Arrangements: undetermined
IR35 Status: undetermined
Seniority Level: undetermined
Industry: Other
Job Description
This role is responsible for the end-to-end administration, validation, and reconciliation of Third-Party Administrator (TPA) claims within Chubb's claims systems. Acting as a key liaison between TPAs, claimants, brokers, and internal teams, the coordinator ensures the accuracy and integrity of claims data, manages complex claim transactions, and facilitates timely settlements. The role requires strong analytical and organizational skills to review, investigate, and resolve claims issues, maintain compliance with company policies and regulatory requirements, and deliver exceptional customer service. Additionally, the coordinator supports process improvements, system enhancements, and team training to drive operational excellence in claims management.
Key Responsibilities:
- Claims Data Management
- Enter, verify, validate, and analyze TPA claim data (new claims, reopening, reserve changes, payments, recoveries, closures) in the Claim Vision system
- Review and assess complex claims end-to-end, including settlement, responding to customer queries, providing updates, and requesting additional information
- Investigate and evaluate complex claims, applying technical knowledge to determine appropriate settlement amounts in accordance with policy terms and conditions
- Communicate regularly with TPAs, oversight teams, TPA Management, claimants, and brokers to ensure funding accuracy, resolve discrepancies, and provide updates
- Manage negotiations with claimants and brokers regarding claims decisions and settlement amounts
- Prepare and send written correspondence (requests for information, settlements, etc.) to brokers, claimants, and other stakeholders
- Ensure loss reserves are set and maintained with timely updates of claims data, ensuring correctness of systems and file records
- Proactively apply claims policies and procedures, including fraud, salvage, recovery, cost containment, and complaints
- Attend to claims enquiries and feedback, maintaining positive relationships with customers, brokers, providers, and other stakeholders
- Immediately report potentially and confirmed fraudulent cases, compliance, and privacy breaches to management
- Attend administrative activities (team huddles, trainings)
- Perform other related duties as assigned by supervisors
Qualifications
- Minimum 3-4 years of similar work experience
- Claims insurance background required
- Excellent analytical skills and strong attention to detail
- Sound knowledge of claims administration procedures and related systems
- Demonstrated strong communication skills (written and verbal) and interpersonal skills for dealing with all levels of Chubb personnel, claimants, and brokers
- Ability to organize work effectively, methodically, and as part of a team
- Adaptability to change driven by business needs
- Ability to multitask, manage workload efficiently, and consistently meet deadlines
- Quality & Customer Service
- Ability to maintain a high level of quality in all claims administration activities, ensuring settlement times and complaint levels are minimized
- Strong investigation techniques and customer service behavior
- Problem-solving skills to quickly identify issues, implement solutions, or escalate to management
- Exercise sound judgment in processing claims, especially when system requirements vary by payment type
