ESIS Senior Claims Representative, WC

Chubb • Garland, TX

3d • Hybrid

About The Position

The Workers’ Compensation Senior Claims Representative under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines. This position is preferred to be in Dallas, TX, Houston, TX or Little Rock, AR.

Requirements

• Workers' Compensation claims experience
• Ability to investigate and settle claims promptly, equitably and within established best practices guidelines.
• Ability to contact, interview, and obtain statements from various parties.
• Ability to evaluate facts and determine liability and company obligation.
• Ability to prepare reports on investigations, settlements, and denials.
• Ability to set reserves within authority limits and recommend changes.
• Ability to review claim progress and status with Team Leader.
• Ability to prepare and submit unusual or undesirable exposures to Team Leader.
• Ability to obtain releases and issue indemnity benefits.
• Ability to inform claimants, insureds/customers, or attorneys of claim denials.
• Ability to assist in preparing cases for trial and settling claims before trial.
• Ability to refer claims to subrogation.
• Ability to participate in claim file reviews and audits.
• Ability to administer Workers’ Compensation benefits timely and appropriately per Jurisdiction.
• Ability to maintain control of claim’s resolution process.
• Ability to establish and maintain strong customer relations.
• Ability to work all queues and diaries in a timely manner.
• Ability to review and approve medical bill payments.
• Ability to manage vocational rehabilitation.

Nice To Haves

• Experience in Dallas, TX, Houston, TX or Little Rock, AR preferred.

Responsibilities

• Receive assignments.
• Reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
• Contacts, interviews, and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.
• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
• Sets reserves within authority limits and recommends reserve changes to Team Leader.
• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
• Prepares and submits to Team Leader unusual or possible undesirable exposures. Assists Team Leader in developing methods and improvements for handling claims.
• Settles claims promptly and equitably.
• Obtains releases and timely issues indemnity benefits if due and owing.
• Informs claimants, insureds/customers, or attorney of denial of claim when applicable.
• May assist Team Leader and company attorneys in preparing cases for trial by taking statements. Continues efforts to settle claims before trial.
• Refers claims to subrogation as appropriate.
• May participate in claim file reviews and audits with customer/insured and broker. Administers Workers’ Compensation benefits timely and appropriately per Jurisdiction. Maintains control of claim’s resolution process to minimize current exposure and future risks.
• Establishes and maintains strong customer relations.
• Working all queues and diary in a timely manner.
• Investigating compensability and benefit entitlement.
• Reviewing and approving medical bill payments.
• Managing vocational rehabilitation.

Benefits

• Employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed