ESIS Claims Representative, WC

Chubb•Cheektowaga, NY

47d

About The Position

Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. At ESIS, we're dedicated to providing exceptional service and innovative solutions, and we're looking for passionate individuals to be part of our dynamic team. If you're eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere! Key Objective: Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines. ESIS, a multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform. ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management.

Requirements

3-5 years experience handling higher level Workers' Compensation claims.
Basic knowledge of claims handling and familiarity with claims terminologies.
Effective negotiation skills.
Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc in a positive manner concerning losses.
Ability to self motivate and work independently.
Knowledge of Chubb products, services, coverages and policy limits, along with awareness of claims best practices
Knowledge of applicable state and local laws
State adjusters licensing a plus or will require future licensing.
Familiar in computer systems
40 words per minute typing skills
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.

Responsibilities

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
Maintaining system logs
Investigating compensability and benefit entitlement
Reviewing and approving medical bill payments or forwarding for outside review as necessary.
Managing vocational rehabilitation