ESIS Senior Claims Representative, WC

Chubb • Buffalo, NY

2d • $71,000 - $104,000

About The Position

Under the direction of the Claims Team Leader, the Senior Workers’ Compensation Claim Representative investigates and resolves claims promptly, fairly, and in accordance with established best practices. This role involves managing new claim assignments, reviewing claim and policy information, conducting investigations, evaluating liability, preparing reports, setting reserves, managing litigation files, and assisting with process improvements. The position also requires administering benefits, maintaining control of the claim resolution process, and establishing strong working relationships with various stakeholders.

Requirements

• Workers' compensation claims handling experience
• Ability to investigate and resolve claims promptly and fairly
• Knowledge of established best practices in claims handling
• Ability to establish reserves within authority limits and recommend changes
• Experience managing litigation files
• Ability to administer benefits in a timely and appropriate manner
• Ability to maintain control of the claim resolution process
• Ability to establish and maintain strong working relationships with stakeholders

Nice To Haves

• Experience in risk management and insurance services
• Experience supporting effective claims handling
• Experience contributing to positive outcomes for employees and clients
• Experience with Chubb's operations and values

Responsibilities

• Receive and manage new claim assignments.
• Review claim and policy information to establish the background for investigation and determine the extent of the policy’s obligation to the insured, depending on the line of business.
• Contact, interview, and obtain statements, recorded or in person, from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather necessary claim information.
• Arrange for surveys and expert evaluations, as appropriate.
• Evaluate facts obtained through investigation to determine liability, if any, and the company’s obligation to the insured under the policy contract.
• Prepare reports related to investigations, settlements, claim denials, and evaluations of involved parties.
• Set 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.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and process improvements for claims handling.
• Resolve claims promptly and fairly.
• Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
• Inform claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
• May assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and taking statements. Continue efforts to resolve claims before trial.
• Refer claims to subrogation, as appropriate.
• May participate in claim file reviews and audits with customers, insureds, and brokers.
• Administer benefits in a timely and appropriate manner.
• Maintain control of the claim resolution process to minimize current exposure and future risk.
• Establish and maintain strong working relationships with agents, underwriters, insureds, experts, and other stakeholders.
• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments or forwarding them for outside review, as necessary
• Managing vocational rehabilitation

Benefits

• Equal employment opportunity
• Compliance with all laws and regulations pertaining to employment
• 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.
• Performance and qualifications as the only basis for hiring, assignment, promotion, compensation, development, and retention.
• Prohibition of unlawful discrimination, harassment, and retaliation.

What This Job Offers

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