Job Description A&H Claim Adjuster ( **Job Number:**

344677 ) * Accurately evaluate and process claims based on relevant documentation

* Evaluate claim submission, determine policy benefits and request additional information as required to finalize claim.

* Manage inquiries, escalations and pending files on claim decisions

* When claim is NIGO, provide clear and concise instructions and feedback to Claim Prep Team (CPT) to request and obtain necessary information for file to be IGO.

* Provide exceptional customer service by promptly following up and collaborating with internal and external business partners to address concerns and/or questions.

* Build broad knowledge of the various online systems for claims processing, imaging and policy administration as it pertains to individual vs. WS products

* Responsible for some re-work from APIs and Genpact SAT

* Maintain appropriate documentation on all claim files and manage caseload in a timely manner while meeting quality standards and SLAs.

* Research, analyze, and interpret policy language and state law as it relates to submitted claims

* Conduct telephone assessments as needed, for continuing disability claims

* Build relationship and leverage SIU team and Genpact partners as appropriate

* Continue to enhance claims adjudication skills with a progression to Sr. Adjuster

* Improve own craft and adapt to new products and technologies

* Performs other duties as assigned

**Qualifications**

Qualifications

**Skills:**

* Exceptional written and verbal communication skills

* Ability to think critically, solve problems, plan and organize activities, serve clients, effectively communicate verbally and in writing with internal, external and CPTs

* Resilient and open to new challenges

* Analytical skill necessary to make decisions and resolve claim issues inherent in handling losses

* Demonstrate integrity with strong work ethic and customer centric focus

* Demonstrate active listening skills through effective use of questions, reflection, and empathy

* Ability to work in a fast -paced environment with frequent customer interaction

* Strong time management and organizational skills with high attention to detail

* Proficient in MS Office Outlook, Word and Excel

* Bilingual in Spanish and English strongly preferred

**Education and Experience:**

* Bachelors Degree in Business or related field from an accredited four -year institution

* 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

* Ability to communicate in multiple languages English, Spanish (Bilingual a plus)

* Knowledge of medical terminology

**Chubb Individual Contributor 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

*ABOUT COMBINED INSURANCE*

*Combined Insurance is a leading provider of individual supplemental accident, disability, health and life insurance products, and a Chubb company. With a field sales force and corporate staff in excess of 4,700 in North America, Combined Insurance meets the growing coverage needs of policyholders. We pride ourselves on being customer-centric, people-driven, accountable, performance-minded, and ethical. We invest in our employees and take the time to focus on their development, needs and career aspirations.*

*Our parent company, Chubb, is one of the worlds largest publicly traded property and casualty insurer. With operations in 54 countries and territories, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients. Parent company Chubb Limited is listed on the New York Stock Exchange (NYSE: CB) and is a component of the S&P 500 index. Chubb maintains executive offices in Zurich, New York, London and other locations, and employs approximately 31,000 people worldwide.*

EEO Statement At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.