ESIS ProClaim Senior Specialist (Hybrid)
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About The Position
ESIS ProClaim is seeking an experienced Senior Claims Specialist. In this role, you will manage general liability and professional liability claims, along with other lines. Under the direction of the AVP and VP of Claims and Claims Team Leader, you will review coverage, investigate the facts of third-party claims, secure evidence, assess and address subrogation/recovery/tenders, apportion liability, and settle claims to achieve the best outcomes within established claim best practices guidelines and client instructions. Your duties will include determining coverage, conducting thorough investigations, and potentially determining the extent of the policy's obligation to the insured depending on the line of business. You will maintain a diary system to ensure each file is reviewed at least every 90 days. Collaboration with defense counsel and litigation will be essential, as you will work effectively and collaboratively, as directed by the client. You will also ensure that detailed 90-day Claim Summary Reports are prepared, providing updates to the client on investigations, potential settlement opportunities, claim denials, reservation of rights, third-party tenders, and recommendations to present at claims review meetings. Additionally, you will post loss and expense reserves in the Claims system within your authority limits and recommend reserve changes above your authority to the AVP and/or VP of Claims. Regular reviews of the progress and status of claims with claims leadership will be necessary, discussing issues, opportunities, tasks, and remedial actions. You will prepare and submit to claims leadership all unusual or potentially undesirable exposures, such as allegations of bad faith or unfair claim practice allegations. Assisting Claims Leadership in formulating improvements in claims handling procedures will also be part of your responsibilities. You will work closely with Partnership Leaders to deliver results, attend meetings, and participate in claim reviews. It is crucial to review and confirm that claims professionals have secured the appropriate releases, proofs of loss, or compensation agreements and issue company drafts in payments for claims. Maintaining claims with the appropriate file notes, reports, photos, and documentation within the claim is essential. You will follow all company and regulatory compliance requirements, update claims timely with Medicare data, and address Medicare reporting and interest. Meeting or exceeding performance goals will be a key expectation in this role.
