ESIS Senior Claims Representative, WC

Chubb Ltd.; Dallas (TX); On-site; USD 70,000 - 90,000; Full time

Job summary

Chubb External in Dallas, TX is seeking a Workers’ Compensation Senior Claims Representative to investigate and settle claims promptly and equitably under established guidelines.

You will work with the Claims Team Leader, review policy information, interview claimants and witnesses, determine liability, set reserves, and communicate decisively with insureds and attorneys. Strong customer relations are essential.

Responsibilities

• Receive assignments
• Review claim and policy information to support investigation and determine extent of policy obligation
• Contact, interview, and obtain statements from insureds, claimants, witnesses, physicians, attorneys, police officers, etc.
• Evaluate facts to determine liability and extent of company obligation
• Prepare reports on investigations, settlements, denials, and evaluations
• Set reserves within authority and suggest changes to Team Leader
• Discuss progress with Team Leader and suggest remedial actions
• Prepare and submit to Team Leader unusual exposures; assist in method improvements
• Settle claims promptly and equitably; obtain releases and indemnity benefits when due
• Inform claimants and insureds or attorneys of denials when applicable
• Assist in case preparation for trial and continue efforts to settle before trial
• Refer claims to subrogation as appropriate
• Participate in claim file reviews and audits; administer workers’ compensation benefits
• Maintain strong customer relations
• Work all queues and diary tasks timely
• Investigate compensability and benefit entitlement
• Review and approve medical bill payments
• Manage vocational rehabilitation

Job description

The Workers’ Compensation Senior Claims Representative, Pension Desk under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.

Duties may include but are not limited to:

• Receive assignments.
• Reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
• Contacts, interviews, and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.
• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
• Sets reserves within authority limits and recommends reserve changes to Team Leader.
• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
• Prepares and submits to Team Leader unusual or possible undesirable exposures. Assists Team Leader in developing methods and improvements for handling claims.
• Settles claims promptly and equitably.
• Obtains releases and timely issues indemnity benefits if due and owing.
• Informs claimants, insureds/customers, or attorney of denial of claim when applicable.
• May assist Team Leader and company attorneys in preparing cases for trial by taking statements. Continues efforts to settle claims before trial.
• Refers claims to subrogation as appropriate.
• May participate in claim file reviews and audits with customer/insured and broker. Administers Workers’ Compensation benefits timely and appropriately per Jurisdiction. Maintains control of claim’s resolution process to minimize current exposure and future risks
• Establishes and maintains strong customer relations

OTHER DUTIES MAY INCLUDE:

• Working all queues and diary in a timely manner
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments
• Managing vocational rehabilitation