ESIS ProClaim Senior Representative, A&H
About The Position
The Accident and Health Adjuster manages a daily inventory of hospital indemnity, hospital accident, and accidental death and dismemberment claims. The role reviews medical documentation, investigates losses, interprets policy language to determine coverage and payment, establishes and evaluates reserves, prepares coverage letters and reports, and provides high-quality customer service. The position reports to the Team Leader. The selected candidate should show initiative, strong organizational and prioritization skills, adaptability, and the ability to work effectively in a fast-paced, changing environment while meeting industry best practices and claim-handling requirements. The selected candidate must work in the office at least three days per week. ESIS, a Chubb company, provides claim and risk management services to commercial clients in the U.S. and globally. ESIS Specialty monitors and analyzes trends and works with clients to identify opportunities to positively impact program costs, using a balanced and customized approach to claims handling and management.
Requirements
- Strong project management skills and ability to work independently.
- Proficiency with Microsoft Office applications, including Excel, Word, and PowerPoint.
- Strong written communication skills, including the ability to document policy interpretation clearly.
- Strong customer service skills.
- Experience using claims-handling systems.
- Ability to work collaboratively, adapt to changing priorities, and contribute positively to a team environment.
- An applicable resident or designated home state adjuster’s license is required for ESIS Field Claims Adjusters. Adjusters who do not fulfill license requirements will not meet ESIS employment requirements for handling claims; ESIS supports independent self-study and allows up to four months to pass the licensing exam.
- Work in the office a minimum of three days per week.
Nice To Haves
- Adjuster licensing preferred.
- Claims-handling experience preferred.
Responsibilities
- Receive assignments and review claim and policy information to support investigations and determine the extent of the policy’s obligation to the insured.
- Contact, interview, and obtain recorded or in-person statements from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather claim information.
- Depending on the line of business, inspect and appraise property damage or arrange for appraisal.
- Evaluate investigation findings to determine liability, if any, and the company’s obligation under the policy contract.
- Prepare reports concerning investigations, settlements, claim denials, and evaluations of involved parties.
- Establish reserves within authority limits and recommend reserve changes to the Team Leader.
- Review claim progress and status with the Team Leader and discuss issues and recommended corrective actions.
- Submit unusual or potentially adverse exposures to the Team Leader for review.
- Assist the Team Leader in developing claims-handling methods and process improvements.
- Settle claims promptly and fairly.
- Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim payments.
- Inform claimants, insureds/customers, or attorneys of claim denials when applicable.
Benefits
- Comprehensive benefits package.
- May be eligible to participate in a discretionary annual incentive program.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
