Job Description




ESIS Senior Claims Representative, WC




Description

Under the direction of the Claims Team Leader, the Workers' Compensation Senior Claims Representative investigates and settles claims promptly, equitably, and in accordance with established best practices guidelines.




Duties may include, but are not limited to:

• Receive assignments.


• Review claim and policy information to provide background for the 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 necessary claim information.


• Evaluate facts gathered through the investigation to determine the extent of the insured's liability, if any, and the company's obligation under the policy contract.


• Prepare reports on 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 problems and recommended corrective actions.


• Submit unusual or potentially undesirable exposures to the Team Leader and assist in developing methods and improvements for claim handling.


• Settle claims promptly and equitably.


• Obtain releases and issue indemnity benefits in a timely manner when due and owing.


• Inform claimants, insureds/customers, or attorneys of claim denials when applicable.


• Assist the Team Leader and company attorneys in preparing cases for trial by taking statements and continuing settlement efforts before trial.


• Refer claims to subrogation as appropriate.


• Participate in claim file reviews and audits with customers, insureds, and brokers as needed.


• Administer Workers' Compensation benefits timely and appropriately in accordance with jurisdictional requirements.


• Maintain control of the claim resolution process to minimize current exposure and future risk.


• Establish and maintain strong customer relationships.

Other duties may include:

• Working all queues and diaries in a timely manner.


• Investigating compensability and benefit entitlement.


• Reviewing and approving medical bill payments.


• Managing vocational rehabilitation.

Qualifications




Education & Experience

• 3-5 years of experience handling workers' compensation claims.


• Knowledge of claims handling and familiarity with claims terminology.


• Effective negotiation skills.


• Strong communication and interpersonal skills, with the ability to interact positively with claimants, customers, insureds, brokers, attorneys, and others regarding losses.


• Ability to self-motivate and work independently, with strong organization and time management skills.


• Knowledge of company products, services, coverages, and policy limits, along with awareness of the company's claims best practices and client service instructions.


• Knowledge of applicable state and local laws.


• Experience in any of the jurisdictions serviced in the region (MD, DC, VA, NC, SC, TN, KY, WV, OH, IN, MI) is preferred but not required.


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

About Us



Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.



At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.