ESIS Senior Claims Representative, WC

Chubb Ltd.; Dallas (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

Chubb Ltd. seeks a Workers’ Compensation Senior Claims Representative on the Pension Desk under the direction of the Claims Team Leader to investigate and settle claims promptly, equitably, and within established guidelines.

Duties include receiving assignments, reviewing policy information, interviews with insureds and witnesses, evaluating liability, preparing reports, setting reserves, and coordinating with attorneys to protect the company’s interests.

Responsibilities

• Receive assignments.
• Reviews claim and policy information to provide background for investigation and determine extent of policy obligation.
• Contacts, interviews, and obtains statements from insureds, claimants, witnesses, physicians, attorneys, police officers, etc.
• Evaluates facts to determine liability and extent of company obligation under the policy.
• Prepares reports on investigation, settlements, denials, and evaluations.
• Sets reserves within authority limits and recommends reserve changes.
• Reviews progress with Team Leader and discusses remedial actions.
• Prepares and submits unusual exposures to Team Leader and develops methods for handling claims.
• Settles claims promptly and equitably; obtains releases and timely indemnity benefits when due.
• Informs claimants of denial when applicable; assists in preparing cases for trial; refers claims to subrogation as appropriate.
• May participate in claim file reviews and audits; maintains control of resolution process to minimize exposure and risk.

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 extent 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