ESIS Senior Claims Representative, WC at Chubb in Cheektowaga, NY

Job description

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. • 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 thinkin