ESIS Senior Claims Representative, WC

Chubb•New York, NY

6d•$71,000 - $104,000

About The Position

Under the direction of a Claims Team Leader or another member of claims management, the Senior Claims Representative investigates and settles workers’ compensation claims promptly, equitably, and in accordance with established best-practice guidelines. The role reviews claim and policy information, gathers evidence, evaluates liability and coverage obligations, manages reserves and litigation, and administers benefits. Depending on the line of business, responsibilities may also include investigating compensability and benefit entitlement, reviewing medical bills, managing vocational rehabilitation, and maintaining system logs. The position also supports improvements to claims-handling methods and maintains effective relationships with customers and other stakeholders.

Requirements

Four-year college degree and/or equivalent work experience; additional degrees such as an MBA may also qualify.
High level of technical claims knowledge and competence in workers’ compensation claims, demonstrated through claims-handling experience at ESIS or a similar organization; five years of claims-handling experience is preferred.
Thorough knowledge of workers’ compensation products, services, and coverages, and a good understanding of applicable legal principles.
Knowledge of workers’ compensation cost-containment programs and proven account-management skills.
Demonstrated ability to plan, organize, and implement general business and people-management practices, through relevant programs, college-level business or legal coursework, or equivalent practical experience.
Effective communication and interpersonal skills for working with subordinates, all levels of ESIS personnel, attorneys, producers, and accounts.
Understanding of team-building theory and its application to ongoing and planned activities.
Ability to evaluate programs and procedures, incorporate improvements, and facilitate and lead groups.
Evaluative thinking, including seeking and considering multiple sources of data to form conclusions and determine courses of action.
Confidence, credibility, and commitment to established strategies and values.
Creativity and self-motivation demonstrated through direct claims handling and related activities.
Ability to manage activities and resource allocation in support of timely, high-quality service and longer-term claims-handling opportunities.

Nice To Haves

Preferably five years of claims-handling experience.
Insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), or AICPCU.
Additional degrees such as an MBA.

Responsibilities

Receive new claim assignments and review claim and policy information to support investigation and assess policy obligations.
Contact and interview insureds, claimants, witnesses, physicians, attorneys, police officers, and other relevant parties; obtain recorded or in-person statements.
Arrange surveys and expert evaluations where appropriate.
Evaluate investigation findings to determine liability and the company’s obligations under the policy.
Prepare reports on investigations, settlements, denials, and evaluations of involved parties.
Set reserves within authority limits and recommend reserve changes to the Claims Team Leader.
Review claim progress and status with the Team Leader and discuss problems and remedial actions.
Manage litigation files appropriately and in a timely manner.
Assist the Team Leader in developing claims-handling methods and improvements.
Settle claims promptly and equitably; obtain releases, proofs of loss, or compensation agreements and issue payments for claims and expenses.
Notify claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
Assist the Team Leader and company attorneys with trial preparation, including arranging witness attendance and taking statements, while continuing settlement efforts before trial.
Refer claims to subrogation as appropriate and participate in claim-file reviews and audits with customers, insureds, and brokers.
Administer benefits appropriately and on time, while managing the claim-resolution process to minimize current exposure and future risk.
Establish and maintain strong customer relationships with agents, underwriters, insureds, and experts.
Depending on the line of business, maintain system logs; investigate compensability and benefit entitlement; review, approve, or refer medical bill payments for outside review; and manage vocational rehabilitation.