ESIS Senior Claims Representative, WC

ESIS Senior Claims Representative, WC

KEY OBJECTIVE:

Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines.

MAJOR DUTIES & RESPONSIBILITIES:

Duties may include but are not limited to:

• Receive new assignments.

• Reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.

• Contacts, interviews and obtains statements (recorded or in person) from insured’s, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.

• Arrange for surveys and experts where appropriate.

• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.

• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.

• Sets reserves within authority limits and recommends reserve changes to Team Leader.

• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.

• Timely and appropriate management of litigation files.

• Assists Team Leader in developing methods and improvements for handling claims.

• Settles claims promptly and equitably.

• Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims and expenses.

• Informs claimants, insured’s/customers/ agents or attorney of denial of claim when applicable.

• May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements.  Continues efforts to settle claims before trial.

• Refers claims to subrogation as appropriate.

• May participate in claim file reviews and audits with customer/insured and broker.

• Administers benefits timely and appropriately.  Maintains control of claim’s resolution process to minimize current exposure and future risks

• Establishes and maintains strong customer relations i.e. agents, underwriters, insureds, experts

Depending on line of business, other duties may include:

• Maintaining system logs

• Investigating compensability and benefit entitlement

• Reviewing and approving medical bill payments or forwarding for outside review as necessary.

• Managing vocational rehabilitation

SCOPE INFORMATION:   The position reports directly to a Claims Team Leader or other member of claims management.

• Review claim and policy information to assess liability and policy obligations.
• Conduct interviews and obtain statements from insureds, claimants, witnesses, physicians, attorneys, and law enforcement.
• Arrange surveys, expert evaluations, and manage necessary investigations.
• Evaluate investigation findings, set and adjust reserves within authority limits, and recommend changes to Team Leader.
• Prepare detailed investigation and settlement reports, including denial justifications.
• Manage litigation files, assist attorneys with trial preparation, and pursue settlement before trial.
• Issue releases, proofs of loss, and draft payment checks for claims and expenses.
• Communicate claim decisions to claimants, insureds, agents, and attorneys promptly.
• Coordinate subrogation referrals and participate in claim audits with brokers and insureds.
• Maintain strong relationships with agents, underwriters, experts, and customers while ensuring timely benefit administration.

• Four-year college degree and/or equivalent work experience or additional degrees (ex. MBA)

• High level of technical claims knowledge and competence in Workers' Comp claims, as evidenced by demonstrated claims handling experience at ESIS (preferably 5 years claims handling experience), or within a similar organization.

• Thorough knowledge of Workers' Compensation products, services, and coverages, along with a good understanding of applicable legal principles.

• Knowledge of WC cost containment programs and proven account management skills a must.

• Insurance Designations such as Associate in Claims (AIC), Associate in Risk Mgt (ARM), AICPCU, etc.

• Ability to plan, organize and implement general business and people management practices, as evidenced by successful completion of Management and Technical Programs, completion of a business or legal college level curriculum, or equivalent related practical work experience.

• Demonstrated effective communication and interpersonal skills to be capable of dealing with subordinates, all levels of ESIS personnel, as well as attorneys, producers, and accounts.

• Demonstrated understanding of the team building theory and how it applies to on going and planned activities.

• Ability to evaluate the effectiveness of various programs and procedures and incorporate improvements. Ability to facilitate and lead group(s) of people.

• Demonstrated evaluative thinking with evidence of seeking out and considering multiple sources of data to form conclusions and determine courses of action.

• Evidence of strengthening personal effectiveness by demonstrating confidence, credibility and commitment to established strategies, and values.

• Demonstrated creativity and self motivation in present position and activities through action and involvement in direct claim handling and other related functions.

• Evidence of the ability to intellectually manage activities and resource allocation issues that are driven by such things as timely, high quality service, and longer term payback opportunities related to claims handling processing.

The pay range for the role is $71,000 to $104,000. The specific offer will depend on an applicant’s skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program.  Chubb offers a comprehensive benefits package, more details on which can be found on our careers website.  The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.