ESIS Senior Claims Representative, WC

Chubb•Buffalo, NY

7d•$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 representative evaluates policy obligations and liability, manages claim exposure and resolution, administers benefits, and maintains customer relationships. Depending on the line of business, the role may also involve investigating compensability and benefit entitlement, reviewing medical bills, managing vocational rehabilitation, and maintaining system logs.

Requirements

Four-year college degree and/or equivalent work experience or additional degrees.
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.
Ability to plan, organize, and implement general business and people-management practices, demonstrated through management and technical program completion, business or legal college-level study, or equivalent practical work 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 how it applies 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 data sources to form conclusions and determine courses of action.
Ability to strengthen personal effectiveness through 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 involving timely, high-quality service and longer-term claims-processing opportunities.

Nice To Haves

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

Responsibilities

Receive new claim assignments.
Review claim and policy information to establish investigation background and, depending on the line of business, determine the extent of the policy’s obligation to the insured.
Contact, interview, and obtain statements from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather claim information.
Arrange surveys and expert services when appropriate.
Evaluate investigative facts to determine the insured’s liability, if any, and the company’s obligations under the policy.
Prepare reports concerning investigations, settlements, 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 payments 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 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 and manage the claim resolution process to minimize current exposure and future risk.
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.