ESIS Claims Representative, WC

Chubb External • Cheektowaga, NY

63d

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!

Responsibilities

• Receive new assignments.
• Review claim and policy information to provide background for investigation and determine the extent of the policy’s obligation to the insured.
• Contact, interview and obtain statements from insured’s, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
• Arrange for surveys and experts where appropriate.
• Evaluate facts supplied by investigation to determine extent of liability of the insured and the company’s obligation to the insured under the policy contract.
• Prepare reports on investigation, settlements, denials of claims, individual evaluation of involved parties.
• Set reserves within authority limits and recommend reserve changes to Team Leader.
• Review progress and status of claims with Team Leader and discuss problems and suggested remedial actions.
• Manage litigation files timely and appropriately.
• Assist Team Leader in developing methods and improvements for handling claims.
• Settle claims promptly and equitably.
• Obtain releases, proofs of loss or compensation agreements and issue company drafts in payments for claims and expenses.
• Inform claimants, insured’s/customers/agents or attorney of denial of claim when applicable.
• Assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements.
• Refer claims to subrogation as appropriate.
• Participate in claim file reviews and audits with customer/insured and broker.
• Administer benefits timely and appropriately.
• Maintain control of claim’s resolution process to minimize current exposure and future risks.
• Establish and maintain strong customer relations with agents, underwriters, insureds, and experts.
• Maintain system logs depending on line of business.
• Investigate compensability and benefit entitlement.
• Review and approve medical bill payments or forward for outside review as necessary.
• Manage vocational rehabilitation.

What This Job Offers