ESIS Senior Claims Representative, WC

Chubb•Cheektowaga, NY

6d•$71,000 - $104,000

About The Position

Under the direction of a Claims Team Leader, the Senior Claims Representative investigates and settles workers’ compensation claims promptly, equitably, and in accordance with established best-practice guidelines. The role handles the claim-resolution process, including investigation, liability and coverage evaluation, reserve management, benefit administration, litigation coordination, and settlement. Depending on the line of business, the role may also investigate compensability and benefit entitlement, review medical bill payments, manage vocational rehabilitation, and maintain system logs. The position reports directly to a Claims Team Leader or another member of claims management. The pay range is $71,000 to $104,000; the specific offer depends on the applicant’s skills and other factors, and the role may be eligible for a discretionary annual incentive program. Chubb offers a comprehensive benefits package, with details available on its careers website. The disclosed pay range may be adjusted for the applicable geographic differential.

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; preferably five years of claims-handling experience.
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.
Effective communication and interpersonal skills for dealing with subordinates, all levels of ESIS personnel, attorneys, producers, and accounts.
Ability to plan, organize, and implement general business and people-management practices, demonstrated through management and technical programs, college-level business or legal curriculum, or equivalent practical experience.
Understanding of team-building theory and its application to ongoing and planned activities.
Ability to evaluate the effectiveness of programs and procedures and incorporate improvements.
Ability to 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 action and involvement in direct claim handling and related functions.
Ability to manage activities and resource allocation issues in support of timely, high-quality service and longer-term claims-handling process improvements.

Nice To Haves

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

Responsibilities

Receive new claim assignments.
Review claim and policy information to establish investigative background and, depending on the line of business, determine the extent of the policy’s obligation to the insured.
Contact, interview, and obtain recorded or in-person statements from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather claim information.
Arrange for surveys and expert services when appropriate.
Evaluate investigative facts to determine the insured’s liability and the company’s obligations under the policy contract.
Prepare reports on 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 problems and proposed remedial actions.
Manage litigation files in a timely and appropriate manner.
Assist the Team Leader in developing methods and improvements for handling claims.
Settle claims promptly and equitably.
Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
Notify claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
Assist the Team Leader and company attorneys in preparing cases for trial, including arranging witness attendance and taking statements; continue efforts to settle claims before trial.
Refer claims to subrogation when appropriate.
Participate in claim file reviews and audits with customers, insureds, and brokers when applicable.
Administer benefits in a timely and appropriate manner.
Control the claim-resolution process to minimize current exposure and future risks.
Establish and maintain strong relationships with agents, underwriters, insureds, and experts.
Depending on the line of business, maintain system logs, investigate compensability and benefit entitlement, review and approve medical bill payments or forward them for outside review, and manage vocational rehabilitation.