ESIS Senior Claims Specialist, WC

Chubb • Buffalo, NY

2d

About The Position

Under the direction of the Claims Team Leader, the Claims Representative investigates and resolves claims promptly, equitably, and in accordance with established best practices. This role involves analyzing claim and policy information, gathering information through interviews and statements, evaluating liability, preparing reports, setting reserves, managing litigation files, and settling claims. The position also requires collaboration with the Team Leader on claim handling improvements and assisting in case preparation for trial. Additionally, the role involves administering benefits, maintaining control of the claim resolution process, and fostering strong relationships with various stakeholders.

Requirements

• Investigate and resolve claims promptly, equitably, and in accordance with established best practices.
• Analyze claim and policy information.
• Gather claim information through interviews and statements.
• Evaluate facts to determine liability and policy obligations.
• Prepare reports on investigations, settlements, denials, and evaluations.
• Set reserves and recommend reserve changes.
• Manage litigation files.
• Assist in developing methods and improvements for claim handling.
• Settle claims.
• Obtain releases, proofs of loss, or compensation agreements.
• Issue company payments for claims and related expenses.
• Inform parties of claim denials.
• Assist in preparing cases for trial.
• Refer claims to subrogation.
• Participate in claim file reviews and audits.
• Administer benefits.
• Maintain control of the claim resolution process.
• Establish and maintain strong relationships with customers, agents, underwriters, and experts.

Responsibilities

• Receive and review new claim assignments.
• Analyze claim and policy information to provide background for investigations and determine the extent of policy obligations.
• Contact, interview, and obtain statements from insureds, claimants, witnesses, physicians, attorneys, police officers, and other relevant parties to gather necessary claim information.
• Arrange for surveys and engage experts as appropriate.
• Evaluate facts obtained during investigations to determine liability and the company’s obligations under the policy contract.
• Prepare reports on investigations, settlements, denials, and evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader as needed.
• Review claim progress and status with the Team Leader, discussing challenges and recommending solutions.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and improvements for claim handling.
• Settle claims promptly and equitably.
• Obtain releases, proofs of loss, or compensation agreements and issue company payments for claims and related expenses.
• Inform claimants, insureds, 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, while continuing efforts to resolve claims before trial.
• Refer claims to subrogation when appropriate.
• Participate in claim file reviews and audits with customers, insureds, and brokers as needed.
• Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize current and future exposure.
• Establish and maintain strong relationships with customers, agents, underwriters, and experts.
• Maintaining system logs.
• Investigating compensability and benefit entitlement.
• Reviewing and approving medical bill payments or forwarding for external review as necessary.
• Managing vocational rehabilitation.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed