ESIS ProClaim Senior Representative

Chubb•Town of Hague, NY

About The Position

ESIS ProClaim is seeking an experienced Senior Claims Representative. Reporting to the AVP and VP of Claims, as well as the Claims Team Leader, this role is responsible for reviewing coverage, investigating third-party claims, securing evidence, assessing subrogation, recovery, and tenders, apportioning liability, and settling claims to achieve optimal outcomes in accordance with established best practices and client instructions.

Requirements

Experience as a Senior Claims Representative
Ability to review coverage
Ability to investigate third-party claims
Ability to secure evidence
Ability to assess subrogation, recovery, and tenders
Ability to apportion liability
Ability to settle claims
Familiarity with established best practices and client instructions
Ability to maintain a diary system for file reviews every 90 days
Ability to collaborate with defense counsel and litigation teams
Ability to prepare detailed 90-day Claim Summary Reports
Ability to provide client updates on investigations, settlement opportunities, claim denials, reservation of rights, third-party tenders, and recommendations for claims review meetings
Ability to post loss and expense reserves within authority limits
Ability to recommend reserve changes above authority
Ability to review claim progress and status with claims leadership
Ability to submit unusual or potentially undesirable exposures to claims leadership
Ability to assist claims leadership in developing improvements to claims handling procedures
Ability to work with Partnership Leaders to deliver results, attend meetings, and participate in claim reviews
Ability to review and confirm appropriate releases, proofs of loss, or compensation agreements
Ability to issue payments for claims
Ability to maintain claims files with accurate notes, reports, photos, and documentation
Adherence to all company and regulatory compliance requirements
Ability to update claims promptly with Medicare data and address Medicare reporting and interests
Ability to meet or exceed performance goals

Responsibilities

Determine coverage, conduct thorough investigations, and assess the extent of policy obligations based on the line of business.
Maintain a diary system to ensure each file is reviewed at least every 90 days.
Collaborate effectively with defense counsel and litigation teams, as directed by the client.
Prepare detailed 90-day Claim Summary Reports and provide updates to clients on investigations, settlement opportunities, claim denials, reservation of rights, third-party tenders, and recommendations for claims review meetings.
Post loss and expense reserves in the claims system within authority limits; recommend reserve changes above authority to AVP and/or VP of Claims.
Review claim progress and status with claims leadership, discussing issues, opportunities, tasks, and remedial actions.
Submit to claims leadership any unusual or potentially undesirable exposures, such as allegations of bad faith or unfair claim practices.
Assist claims leadership in developing improvements to claims handling procedures.
Work with Partnership Leaders to deliver results, attend meetings, and participate in claim reviews.
Review and confirm that claims professionals have secured appropriate releases, proofs of loss, or compensation agreements, and issue payments for claims.
Maintain claims files with accurate notes, reports, photos, and documentation.
Adhere to all company and regulatory compliance requirements.
Update claims promptly with Medicare data and address Medicare reporting and interests.
Meet or exceed performance goals.