ESIS Senior Claims Representative, WC

Chubb•Cheektowaga, NY

48d•$79,000 - $134,300

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! As an ESIS Claims Specialist, your primary responsibility will be to investigate and resolve claims efficiently and fairly under the guidance of the Claims Team Leader. Your goal is to ensure that all claims are processed in accordance with established best practices, while delivering exceptional service to our clients.

Requirements

A bachelor's degree in a relevant field or comparable work experience, with additional qualifications (e.g., MBA) being a valuable asset.
A minimum of 5 years of proven experience in claims handling, preferably within ESIS or a similar organization. Expertise in Workers' Compensation claims is essential, demonstrating thorough technical knowledge and competence.
In-depth knowledge of Workers' Compensation products, services, coverages, and relevant legal principles that govern them.
Familiarity with Workers' Compensation cost containment strategies and a track record of effective account management are crucial for this role.
Strong Business and People Management Skills: Possess the ability to plan, organize, and implement effective business and personnel management practices. This should be evidenced through successful completion of management or technical programs or equivalent practical work experience.
Exceptional Communication Skills: Proven ability to communicate effectively and build relationships with diverse stakeholders, including subordinates, ESIS personnel, attorneys, producers, and clients.
Demonstrated understanding of team dynamics and the application of team-building principles in both ongoing and planned activities.
Ability to assess the effectiveness of various programs and procedures, identifying opportunities for improvement while facilitating and leading group initiatives.
Strong evaluative thinking abilities, adept at sourcing and analyzing multiple data points to make informed conclusions and determine actionable strategies.
Evidence of cultivating personal effectiveness through confidence, credibility, and a commitment to the organization's established strategies and values.
A proactive approach to work, showcasing creativity and self-motivation in claims handling and related functions, driving engagement and improvement.
Demonstrated capability to manage activities and resource allocation effectively, prioritizing timely, high-quality service alongside long-term benefits related to claims processing.
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.

Nice To Haves

Relevant insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), or AICPCU are highly desirable and reflect commitment to professional development.

Responsibilities

Claim Assignment and Review: Promptly receive and review new assignments, analyzing claim and policy information to set the foundation for thorough investigations, while assessing the policy's obligations based on the specific line of business.
Information Gathering: Conduct in-depth interviews and secure statements (both recorded and in-person) from insured parties, claimants, witnesses, healthcare providers, legal representatives, and law enforcement to collect essential claim information.
Expert Coordination: Collaborate with experts and arrange for surveys when necessary to support claims investigations.
Liability Evaluation: Assess the facts obtained during investigations to determine the insured's liability, if applicable, and the extent of the company's obligations under the policy contract.
Reporting and Documentation: Prepare comprehensive reports that encompass investigation findings, claim settlements, denials, and evaluations of involved parties to maintain accurate and current records.
Reserve Management: Set reserves within your authority limits and recommend changes to reserves to the Claims Team Leader as appropriate.
Claims Progress Review: Regularly discuss the status and progress of claims with the Claims Team Leader, addressing any challenges and proposing solutions.
Litigation Management: Oversee litigation files proactively to ensure timely and appropriate management, while striving to settle claims before progressing to trial.
Assist with Legal Preparations: Support the Team Leader and company attorneys in trial preparations by organizing witness attendance and collecting statements, while actively seeking opportunities to settle claims prior to litigation.
Subrogation Referrals: Identify and refer claims for subrogation as relevant to recover costs.
File Audits and Reviews: Participate in claim file reviews and audits alongside customers, insured parties, and brokers to ensure compliance and accuracy.
Timely Benefits Administration: Administer benefits promptly and fairly, while maintaining control of the claims resolution process to mitigate risk and exposure.
Customer Relationship Management: Establish and uphold strong relationships with all stakeholders, including agents, underwriters, insured parties, and industry experts, to enhance customer satisfaction.
Maintain accurate system logs.
Investigate compensability and benefits entitlement.
Review and authorize medical bill payments or coordinate external assessments as necessary.
Manage vocational rehabilitation processes as needed.