ESIS Senior Claims Representative, WC

ESIS Senior Claims Representative, WC , Cheektowaga, NY

Under the direction of the Claims Team Leader, the Senior Workers’ Compensation Claim Representative investigates, evaluates, and resolves claims in a timely, fair, and consistent manner, in accordance with established best practices and applicable policy provisions.

Duties may include, but are not limited to:

• Receive and manage new claim assignments.
• Review claim and policy information to establish the basis for investigation and determine the extent of the policy’s obligation to the insured, depending on the line of business.
• Contact, interview, and obtain statements, recorded or in person, from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather relevant claim information.
• Arrange surveys and expert evaluations, as appropriate.
• Evaluate facts obtained through investigation to determine liability, if any, and the company’s obligation to the insured under the policy contract.
• Prepare reports related to 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 issues and recommended corrective actions.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and process improvements for claims handling.
• Resolve claims in a timely and fair manner.
• Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
• Inform claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and taking statements, while continuing efforts to resolve claims before trial.
• Refer claims to subrogation, as appropriate.
• Participate in claim file reviews and audits with customers, insureds, and brokers, as needed.
• Administer benefits in a timely and appropriate manner and maintain control of the claim resolution process to help minimize current exposure and future risk.
• Establish and maintain effective working relationships with agents, underwriters, insureds, experts, and other stakeholders.

Depending on the line of business, other duties may include:

• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments or forwarding them for outside review, as necessary
• Managing vocational rehabilitation

Experience & Education 

• Bachelor’s degree or equivalent work experience required; additional education, such as an MBA, is preferred.
• Strong technical knowledge and proficiency in workers’ compensation claims, supported by claims handling experience at ESIS or a similar organization; five or more years of claims handling experience is preferred.
• Thorough knowledge of workers’ compensation products, services, and coverages, along with a solid understanding of applicable legal principles.
• Knowledge of workers’ compensation cost containment programs and strong account management skills.
• Professional insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), AICPCU, or equivalent are preferred.
• Ability to plan, organize, and implement general business and people management practices, supported by management or technical training, business or legal coursework, or equivalent related practical experience.
• Strong communication and interpersonal skills, with the ability to work effectively with colleagues at all levels, as well as attorneys, producers, and clients.
• Understanding of team-building principles and how they apply to ongoing and planned activities.
• Ability to evaluate the effectiveness of programs and procedures, recommend improvements, and facilitate or lead groups.
• Strong evaluative thinking skills, with the ability to consider multiple sources of information when forming conclusions and determining courses of action.
• Demonstrated professionalism, credibility, and commitment to established strategies and values.
• Creativity and self-motivation demonstrated through direct claim handling and related responsibilities.
• Ability to manage activities and allocate resources effectively in support of timely, high-quality service and long-term claims handling objectives.

An applicable resident or designated home state adjuster’s license is required for ESIS Field Claims Adjusters.  Adjusters that do not fulfill the license requirements will not meet ESIS’s employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.

The pay range for the role is $71,000 to $104,000. The specific offer will depend on an applicant’s skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program.  Chubb offers a comprehensive benefits package, more details on which can be found on our careers website.  The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.