ESIS Senior Claims Representative, WC

About the role

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

Responsibilities

• Receive assignments and review claim and policy information to provide background for investigation; determine the extent of the policy’s obligation to the insured.
• Contact, interview, and obtain statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc., to secure necessary claim information.
• Evaluate facts supplied by investigation to determine extent of liability of the insured and the company’s obligation under the policy contract.
• Prepare reports on investigation, 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.
• Prepare and submit unusual or possible undesirable exposures to the Team Leader.
• Assist the Team Leader in developing methods and improvements for handling claims.
• Settle claims promptly and equitably; obtain releases and issue indemnity benefits if due and owing.
• Inform claimants, insureds/customers, or attorneys of claim denial when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial by taking statements and continue efforts to settle claims before trial.
• Refer claims to subrogation as appropriate.
• Participate in claim file reviews and audits with customers/insureds and brokers.
• Administer Workers’ Compensation benefits timely and appropriately per jurisdiction.
• Maintain control of the claim’s resolution process to minimize current exposure and future risks.
• Establish and maintain strong customer relations.
• Work all queues and diary in a timely manner.
• Investigate compensability and benefit entitlement.
• Review and approve medical bill payments.
• Manage vocational rehabilitation.

Qualifications

• 5-7 years’ experience handling Workers’ Compensation claims in Texas.
• Knowledge of claims handling and familiarity with claims terminologies.
• Effective negotiation skills.
• Strong communication and interpersonal skills to interact positively with claimants, customers, insureds, brokers, and attorneys.
• Ability to self-motivate, work independently, and excel in organization and time management.
• Knowledge of company products, services, coverages, policy limits, and awareness of claims best practices and client service instructions.
• Knowledge of applicable state and local laws.
• An applicable resident or designated home state adjuster’s license is required; ESIS supports independent self-study 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. The company provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. Chubb is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, and superior claims handling expertise.