Apply on Employer Site

Chubb · 2 months ago

ESIS Senior Claims Representative, WC

Cheektowaga, NY

Full-time

Onsite

Mid, Senior Level

$79K/yr - $134K/yr

5+ years exp

Chubb is a world leader in insurance, dedicated to providing exceptional service and innovative solutions. As a Senior Claims Representative at ESIS, you will investigate and resolve workers' compensation claims, ensuring compliance with best practices while delivering outstanding service to clients.

Commercial InsuranceFinancial ServicesHealth InsuranceInsuranceMortgageRisk Management

Responsibilities

Claim Assignment and Review: Promptly receive and review new assignments, analyzing claim and policy information to set the foundation for thorough investigations, while assessing the policy’s obligations based on the specific line of business

Information Gathering: Conduct in-depth interviews and secure statements (both recorded and in-person) from insured parties, claimants, witnesses, healthcare providers, legal representatives, and law enforcement to collect essential claim information

Expert Coordination: Collaborate with experts and arrange for surveys when necessary to support claims investigations

Liability Evaluation: Assess the facts obtained during investigations to determine the insured's liability, if applicable, and the extent of the company’s obligations under the policy contract

Reporting and Documentation: Prepare comprehensive reports that encompass investigation findings, claim settlements, denials, and evaluations of involved parties to maintain accurate and current records

Reserve Management: Set reserves within your authority limits and recommend changes to reserves to the Claims Team Leader as appropriate

Claims Progress Review: Regularly discuss the status and progress of claims with the Claims Team Leader, addressing any challenges and proposing solutions

Litigation Management: Oversee litigation files proactively to ensure timely and appropriate management, while striving to settle claims before progressing to trial

Assist with Legal Preparations: Support the Team Leader and company attorneys in trial preparations by organizing witness attendance and collecting statements, while actively seeking opportunities to settle claims prior to litigation

Subrogation Referrals: Identify and refer claims for subrogation as relevant to recover costs

File Audits and Reviews: Participate in claim file reviews and audits alongside customers, insured parties, and brokers to ensure compliance and accuracy

Timely Benefits Administration: Administer benefits promptly and fairly, while maintaining control of the claims resolution process to mitigate risk and exposure

Customer Relationship Management: Establish and uphold strong relationships with all stakeholders, including agents, underwriters, insured parties, and industry experts, to enhance customer satisfaction

Maintain accurate system logs

Investigate compensability and benefits entitlement

Review and authorize medical bill payments or coordinate external assessments as necessary

Manage vocational rehabilitation processes as needed

Qualification

Workers' Compensation expertiseClaims handling experienceCost containment strategiesInsurance designationsAnalytical evaluation skillsTeam building experienceResource managementCommunication skillsCreativityInitiative

Required

A bachelor's degree in a relevant field or comparable work experience, with additional qualifications (e.g., MBA) being a valuable asset

A minimum of 5 years of proven experience in claims handling, preferably within ESIS or a similar organization. Expertise in Workers' Compensation claims is essential, demonstrating thorough technical knowledge and competence

In-depth knowledge of Workers' Compensation products, services, coverages, and relevant legal principles that govern them

Familiarity with Workers' Compensation cost containment strategies and a track record of effective account management are crucial for this role

Relevant insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), or AICPCU are highly desirable and reflect commitment to professional development

Possess the ability to plan, organize, and implement effective business and personnel management practices. This should be evidenced through successful completion of management or technical programs or equivalent practical work experience

Proven ability to communicate effectively and build relationships with diverse stakeholders, including subordinates, ESIS personnel, attorneys, producers, and clients

Demonstrated understanding of team dynamics and the application of team-building principles in both ongoing and planned activities

Ability to assess the effectiveness of various programs and procedures, identifying opportunities for improvement while facilitating and leading group initiatives

Strong evaluative thinking abilities, adept at sourcing and analyzing multiple data points to make informed conclusions and determine actionable strategies

Evidence of cultivating personal effectiveness through confidence, credibility, and a commitment to the organization's established strategies and values

A proactive approach to work, showcasing creativity and self-motivation in claims handling and related functions, driving engagement and improvement

Demonstrated capability to manage activities and resource allocation effectively, prioritizing timely, high-quality service alongside long-term benefits related to claims processing

An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims