ESIS Senior Claims Representative, WC

Chubb•Buffalo, NY

6d•$71,000 - $104,000

About The Position

The Senior Claims Representative, WC is a collaborative, analytical, and customer-focused claims professional with strong technical knowledge of workers’ compensation claims and the ability to manage complex files independently. This role involves receiving and managing new claim assignments, reviewing claim and policy information, and conducting investigations to determine the extent of the company’s obligation under the policy. The representative will gather information by contacting various parties, evaluate facts to determine liability, and prepare reports on investigations, settlements, and evaluations. They will also establish and recommend reserves, manage litigation files, and identify process improvements. The goal is to resolve claims promptly and equitably, administer benefits appropriately, and build strong working relationships with partners. Accurate system logs and documentation are essential.

Requirements

Four-year college degree and/or equivalent work experience.
High level of technical claims knowledge and competence in workers’ compensation claims, demonstrated through claims handling experience at ESIS or a similar organization, preferably 5+ years.
Strong knowledge of workers’ compensation products, services, coverages, and applicable legal principles.
Knowledge of WC cost containment programs and strong account management skills.
Ability to plan, organize, and implement business and people management practices, supported by relevant education or equivalent practical experience.
Strong communication and interpersonal skills with the ability to work effectively across all levels of the organization and with external partners.
Understanding of team-building principles and how they support ongoing and planned activities.
Ability to evaluate programs and procedures and recommend improvements.
Ability to facilitate and lead groups effectively.
Strong evaluative thinking skills, including the ability to gather and assess multiple sources of information before making decisions.
Demonstrated professionalism, credibility, and commitment to organizational strategies and values.
Creativity and self-motivation, with evidence of initiative in claim handling and related responsibilities.
Ability to manage priorities and resources effectively in support of timely, high-quality service and long-term claims outcomes.
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

Advanced degrees such as an MBA are a plus.
Insurance designations such as AIC, ARM, AICPCU, or similar credentials are preferred.
ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.

Responsibilities

Receive and manage new claim assignments.
Review claim and policy information to support investigation and determine the extent of the company’s obligation under the policy, as applicable.
Contact and interview insureds, claimants, witnesses, physicians, attorneys, police officers, and other relevant parties to gather necessary claim information.
Arrange surveys and engage experts when appropriate.
Evaluate facts gathered through investigation to determine liability and the company’s obligation under the policy contract.
Prepare reports related to 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 challenges and recommended next steps.
Manage litigation files in a timely and appropriate manner.
Support the Team Leader in identifying process improvements and enhanced claim handling methods.
Resolve claims promptly and equitably.
Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
Communicate claim denials to claimants, insureds, customers, agents, or attorneys, as appropriate.
Support the Team Leader and company attorneys in trial preparation by coordinating witness attendance and obtaining statements, while continuing settlement efforts when possible.
Refer claims to subrogation as appropriate.
Participate in claim file reviews and audits with customers, insureds, and brokers.
Administer benefits in a timely and appropriate manner while maintaining control of the claim resolution process to help minimize current exposure and future risk.
Build and maintain strong working relationships with agents, underwriters, insureds, experts, and other partners.
Maintain accurate system logs and documentation.