ESIS Claims Representative, AGL

Chubb•Detroit, MI

About The Position

Manage Auto Liability matters, including 1st Party Claims (PIP, UIM, UM, medical billing review, and reporting) and 3rd Party Claims (bodily injury and property damage, liability determination, negotiation, and total loss handling).

Requirements

Manage Auto Liability matters
Interpret appropriate policy to determine coverage
PIP (Med pay), UIM, UM claims
Recommend when IME’s would be need. When approved coordinate IME’s through vendor
Determine if Medical billing is related to claimed injuries
Speak with claimant related to treatment plans and recommend case management when necessary
Mail all medical bills to vendor to have them looked at for relevancy and fair and customary billing amounts
Payment of appropriate medical bills
Determine reportable files per agreement with insurance company and give claim status reports to insurance company
ORM Reporting: Determining what claims with ongoing responsibility for medical.
Explain why claims need to be reported based on particular no-fault status
MCCA: Submit reimbursement requests
Determine if certain expenses need prior MCCA approval for payment and seek approval if needed
Provide semiannual claim status reports
All US claims for bodily injury and property damage (except for MI Mini Tort)
Determine if claims can be tendered to events or TNC if indemnity agreement exists
Gather claim information
Determine liability based on facts available and applicable state law
Assign appraisers when necessary, through Audatex system
Review repair estimates and determine if appraisal is needed
Review medical documentation for bodily injury claims
Work with ESIS Total Loss Team for total loss of 3rd party vehicles
Negotiate claims with plaintiff counsel or claimant directly for BI and PD claims

Responsibilities

Interpret appropriate policy to determine coverage for 1st party claims.
Handle PIP (Med pay), UIM, and UM claims.
Recommend and coordinate Independent Medical Examinations (IMEs) through vendors.
Determine if medical billing is related to claimed injuries.
Communicate with claimants regarding treatment plans and recommend case management.
Process medical bills for relevancy and fair/customary amounts.
Approve and pay appropriate medical bills.
Determine reportable files and provide claim status reports to insurance companies.
Handle ORM Reporting, determining claims with ongoing medical responsibility and explaining reporting requirements.
Manage MCCA reimbursements, seek prior approval for expenses, and provide semiannual claim status reports.
Handle all US 3rd party bodily injury and property damage claims (except MI Mini Tort).
Determine if claims can be tendered to events or TNC based on indemnity agreements.
Gather claim information for 3rd party claims.
Determine liability based on available facts and applicable state law.
Assign appraisers through the Audatex system when necessary.
Review repair estimates and determine if an appraisal is needed.
Review medical documentation for bodily injury claims.
Collaborate with the ESIS Total Loss Team for 3rd party vehicle total losses.
Negotiate claims with plaintiff counsel or claimants directly for BI and PD claims.