ESIS Claims Representative, WC

Chubb•Buffalo, NY

6d•$57,000 - $83,000•Hybrid

About The Position

The ESIS Claims Representative, Workers’ Compensation, investigates and settles claims promptly and equitably within established best-practice guidelines. Under the direction of a Claims Team Leader, the representative reviews claim and policy information, gathers information from involved parties, evaluates liability and coverage, sets reserves within authority, manages litigation files, and administers benefits and claim resolutions. The role works to minimize current exposure and future risks while maintaining strong relationships with customers and other stakeholders. The position is hybrid, with three days in the office and one day remote. It reports directly to a Claims Team Leader or another member of claims management. Depending on the line of business, additional duties may include maintaining system logs, investigating compensability and benefit entitlement, reviewing medical bills, and managing vocational rehabilitation.

Requirements

1–2 years of experience handling higher-level Workers’ Compensation claims.
Basic knowledge of claims handling and familiarity with claims terminology.
Effective negotiation skills.
Strong communication and interpersonal skills, including the ability to interact positively with claimants, customers, insureds, brokers, attorneys, and others regarding losses.
Ability to self-motivate and work independently.
Knowledge of ACE products, services, coverages, and policy limits, and awareness of ACE claims best practices.
Knowledge of applicable state and local laws.
Familiarity with computer systems.
Typing speed of 40 words per minute.

Nice To Haves

State adjuster’s license; future licensing may be required.

Responsibilities

Receive new claim assignments and review claim and policy information to establish investigative background and determine the extent of policy obligations.
Contact and interview insureds, claimants, witnesses, physicians, attorneys, police officers, and others, obtaining statements as needed.
Arrange surveys and expert services when appropriate.
Evaluate investigation findings to determine insured liability and the company’s obligations under the policy.
Prepare reports on investigations, settlements, claim denials, and evaluations of involved parties.
Set reserves within authority limits and recommend reserve changes to the Claims Team Leader.
Review claim progress and status with the Claims Team Leader and discuss problems and proposed remedial actions.
Manage litigation files appropriately and in a timely manner.
Assist the Claims 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 for claim and expense payments.
Inform claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
Help the Claims Team Leader and company attorneys prepare cases for trial, including arranging witness attendance and taking statements, while continuing settlement efforts before trial.
Refer claims to subrogation when appropriate.
Participate in claim file reviews and audits with customers, insureds, and brokers.
Administer benefits in a timely and appropriate manner and maintain control of the claim resolution process to minimize exposure and future risks.
Build and maintain strong customer relations with agents, underwriters, insureds, and experts.
Depending on the line of business, maintain system logs, investigate compensability and benefit entitlement, review or refer medical bill payments, and manage vocational rehabilitation.