The Claims Adjuster is responsible for contacting claimant and /or service providers to request information needed in order to process claim - includes written correspondence and phone calls. They will evaluate claims based on documentation received including responses from claimant and providers.
Will need to handle multiple priorities simultaneously, be self-directed and meet service level expectations.
The adjuster must demonstrate customer centricity in all aspects of their job by performing actions with empathy and expertise.
RESPONSIBILITIES:
- Efficiently and accurately adjudicate claims in accordance with the policy terms, established guidelines and regulations.
- Conduct eligibility claim review by evaluating claim submission and comparing to policy benefits.
- Request additional information from policyholders, providers and others as necessary to finalize claim.
- Actively manage inventory and ongoing claim adjudication.
- Effectively communicate with customers using empathy and professionalism via phone and written correspondence.
- Interface with Policyholders and Agents answering a variety of questions through different service channels.
- Develop a broad understanding of our products and systems.
- Meet Department standards for time, service and quality.
- Ability to maneuver between system applications confidently to find information and respond to customer needs in a timely manner.
- Collaborate with other team members and leadership to ensure effective customer service.
- Actively engage in Continuous Improvement initiatives and identify process and efficiency enhancements.
- Participate in required training
- Performs other duties as assigned
COMPETENCIES:
- Problem Solving: Takes an organized and logical approach to thinking through problems and complex issues. Simplifies complexity by breaking down issues into manageable parts. Looks beyond the obvious to get at root causes. Develops insight into problems, issues and situation.
- Continuous Learning: Demonstrates a desire and capacity to expand expertise, develop new skills and grow professionally. Seeks and takes ownership of opportunities to learn, acquire new knowledge and deepen technical expertise. Takes advantage of formal and informal developmental opportunities. Takes on challenging work assignments that lead to professional growth
- Initiative: Willingly does more than is required or expected in the job. Meets objectives on time with minimal supervision. Eager and willing to go the extra mile in terms of time and effort. Is self-motivated and seizes opportunities to make a difference.
- Adaptability: Ability to re-direct personal efforts in response to changing circumstances. Is receptive to new ideas and new ways of doing things. Effectively prioritizes according to competing demands and shifting objectives. Can navigate through uncertainty and knows when to change course
- Results Orientation: Effectively executes on plans, drives for results and takes accountability for outcomes. Perseveres and does not give up easily in challenging situations. Recognizes and capitalizes on opportunities. Takes full accountability for achieving (or failing to achieve) desired results
- Values Orientation: Upholds and models Chubb values and always does the right thing for the company, colleagues and customers. Is direct truthful and trusted by others. Acts as a team player. Acts ethically and maintains a high level of professional integrity. Fosters high collaboration within own team and across the company; constantly acts and thinks “One Chubb”
SKILLS:
- Exceptional written and verbal communication skills
- Quality and Customer Centric Orientation
- Excellent organizational skills
- Ability to multi-task in fast-paced environment with attention to detail and prioritize tasks
- Analytical skills and good decision-making skills
- Proficient in MS Office – Outlook, Word and Excel
- Navigation between systems and use of technology is important
- Insurance/Claims Experience
- Windows based PC Knowledge
- Bilingual in Spanish and English a plus
EDUCATION AND EXPERIENCE:
- 3 or more years related claims experience required (disability management and critical care desired)
- Experience in a customer interfacing position with progressive responsibility in role
- Knowledge of medical terminology
