ESIS Senior Claims Representative, WC

Chubb•Philadelphia, PA

4h•$71,000 - $104,000

About The Position

Under the direction of the Claims Team Leader, this role investigates and settles claims promptly, equitably, and in accordance with established best-practice guidelines. The Senior Claims Representative, WC will manage claims, build strong customer relationships, and contribute to the development of claims handling methods and improvements.

Requirements

Four-year college degree and/or equivalent work experience.
Strong technical claims knowledge and demonstrated competence in Workers’ Compensation claims, supported by claims handling experience at ESIS (preferably 5 years) or within a similar organization.
Thorough knowledge of Workers’ Compensation products, services, and coverages, along with a solid understanding of applicable legal principles.
Knowledge of WC cost containment programs and proven account management skills.
Demonstrated effective communication and interpersonal skills, with the ability to work effectively with team members, all levels of ESIS personnel, attorneys, producers, and accounts.
Ability to evaluate the effectiveness of programs and procedures and recommend improvements.
Demonstrated evaluative thinking, including the ability to gather and consider multiple sources of data to form conclusions and determine next steps.
Evidence of personal effectiveness, including confidence, credibility, and commitment to established strategies and values.
Demonstrated creativity and self-motivation in current role and related activities through direct claim handling and other related functions.
Ability to manage activities and resource allocation effectively in support of timely, high-quality service and long-term value in claims handling.
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.
ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.

Nice To Haves

Additional degrees such as an MBA are a plus.

Responsibilities

Receive new assignments.
Review claim and policy information to establish 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 secure necessary claim information.
Arrange for surveys and experts where appropriate.
Evaluate facts gathered through investigation to determine the extent of liability of the insured, if any, and the company’s obligation to the insured under the policy contract.
Prepare reports on investigations, settlements, claim denials, and individual 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 improvements for claims handling.
Settle claims promptly and equitably.
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 settle 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.
Build and maintain strong customer relationships with agents, underwriters, insureds, and experts.