ESIS Claims Representative, WC

Chubb European Group Ltd.; Town of Cheektowaga (NY); Hybrid; USD 52,000 - 78,000; Full time

Job summary

Chubb Ltd. is seeking an ESIS Claims Representative for Workers' Compensation to join a hybrid team in the Cheektowaga/Philadelphia markets.

You will investigate, document, and settle workers' compensation claims in accordance with policy terms and established guidelines. Under the direction of the Claims Team Leader, you will interview claimants and witnesses, obtain medical and legal information, set reserves, and collaborate with investigators, physicians, and attorneys to resolve claims

Qualifications

• Receive new assignments.
• Review claim and policy information to provide background 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 secure necessary claim information.

Responsibilities

• Arrange for surveys and experts where appropriate.
• Evaluate facts supplied by investigation to determine the extent of liability of the insured, if any, and the company’s obligation to the insured under the policy contract.
• Prepare reports on investigations, settlements, denials of claims, and individual evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader.
• Review progress and status of claims with the Team Leader and discuss problems and suggested remedial actions.
• Manage litigation files in a timely and appropriate manner.

Job description

ESIS Claims Representative, WC

Locations: Cheektowaga, VA | Philadelphia, PA

Work Arrangement

This role follows a hybrid schedule of 3 days in office and 1 day remote.

Key Objective

Under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably, and within established best practices guidelines.

Major Duties & Responsibilities

Duties may include, but are not limited to:

• Receive new assignments.


• Review claim and policy information to provide background 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 secure necessary claim information.


• Arrange for surveys and experts where appropriate.


• Evaluate facts supplied by investigation to determine the extent of liability of the insured, if any, and the company’s obligation to the insured under the policy contract.


• Prepare reports on investigations, settlements, denials of claims, and individual evaluations of involved parties.


• Set reserves within authority limits and recommend reserve changes to the Team Leader.


• Review progress and status of claims with the Team Leader and discuss problems and suggested 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 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; continue efforts to settle claims before trial.


• Refer claims to subrogation as appropriate.


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


• Administer benefits timely and appropriately, maintaining control of the claim resolution process to minimize current exposure and future risks.


• Establish and maintain strong customer relations with agents, underwriters, insureds, and experts.

Depending on Line of Business, Other Duties May Include

• Maintaining system logs


• Investigating compensability and benefit entitlement


• Reviewing and approving medical bill payments or forwarding for outside review as necessary


• Managing vocational rehabilitation

Scope Information

The position reports directly to a Claims Team Leader or other member of claims management.