ESIS Senior Claims Representative, WC

Chubb•Buffalo, NY

7d•$71,000 - $104,000

About The Position

The ESIS Senior Claims Representative, Workers’ Compensation, manages workers’ compensation claims with technical expertise, sound judgment, and strong customer service. The role works with internal and external stakeholders to investigate claims, evaluate liability and exposure, and pursue timely, equitable resolutions. The position may manage complex files independently and administer benefits while maintaining control of claim resolution to minimize current exposure and future risk. The position also supports the Team Leader with claim reviews, process improvements, and trial preparation, and maintains strong working relationships with agents, underwriters, insureds, experts, and other partners. An applicable resident or designated home-state adjuster’s license is required for ESIS Field Claims Adjusters. Adjusters who do not meet the licensing requirements will not meet ESIS employment requirements for handling claims; ESIS supports independent study time and allows up to four months to pass the adjuster licensing exam.

Requirements

Four-year college degree and/or equivalent work experience.
High-level technical claims knowledge and competence in workers’ compensation claims, demonstrated through claims-handling experience at ESIS or a similar organization; preferably five or more years.
Strong knowledge of workers’ compensation products, services, coverages, and applicable legal principles.
Knowledge of workers’ compensation cost-containment programs and strong account-management skills.
Ability to plan, organize, and implement business and people-management practices, supported by relevant education or equivalent practical experience.
Strong communication and interpersonal skills and ability to work effectively across organizational levels and with external partners.
Understanding of team-building principles and their support of ongoing and planned activities.
Ability to evaluate programs and procedures and recommend improvements.
Ability to facilitate and lead groups effectively.
Strong evaluative thinking, including gathering and assessing multiple sources of information before making decisions.
Professionalism, credibility, and commitment to organizational strategies and values.
Creativity and self-motivation, with initiative in claims handling and related responsibilities.
Ability to manage priorities and resources effectively to support timely, high-quality service and long-term claims outcomes.
For ESIS Field Claims Adjusters, an applicable resident or designated home-state adjuster’s license is required. ESIS allows up to four months to pass the adjuster licensing exam.

Nice To Haves

An advanced degree such as an MBA.
Insurance designations such as AIC, ARM, AICPCU, or similar credentials.

Responsibilities

Receive and manage new claim assignments.
Review claim and policy information to support investigations and determine the extent of the company’s obligations under the policy, as applicable.
Contact and interview insureds, claimants, witnesses, physicians, attorneys, police officers, and other relevant parties to gather claim information.
Arrange surveys and engage experts when appropriate.
Evaluate investigation findings to determine liability and the company’s obligations under the policy contract.
Prepare reports concerning investigations, settlements, claim denials, and evaluations of involved parties.
Establish reserves within authority limits and recommend reserve changes to the Team Leader.
Review claim progress and status with the Team Leader and discuss challenges and recommended next steps.
Manage litigation files in a timely and appropriate manner.
Support the Team Leader in identifying process improvements and enhanced claim-handling methods.
Resolve claims promptly and equitably.
Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
Communicate claim denials to claimants, insureds, customers, agents, or attorneys, as appropriate.
Support the Team Leader and company attorneys with trial preparation by coordinating witness attendance and obtaining statements, while continuing settlement efforts when possible.
Refer claims to subrogation when appropriate.
Participate in claim file reviews and audits with customers, insureds, and brokers.
Administer benefits in a timely and appropriate manner while managing claim resolution to help minimize current exposure and future risk.
Build and maintain working relationships with agents, underwriters, insureds, experts, and other partners.
Maintain accurate system logs and documentation.