ESIS – Professional Associate – Claims (338434)
ESIS – Professional Associate – Claims
ESIS®, Inc., a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS’ innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients’ unique risk management needs. With more than 60 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry’s broadest selections of risk management solutions covering both pre and post-loss services.
- 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.
- 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 insured’s, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
- Arrange for surveys and experts where appropriate.
- 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.
- Timely and appropriate management of litigation files.
- Assists Team Leader in developing methods and improvements for handling claims.
- Settles claims promptly and equitably.
- Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims and expenses.
- Informs claimants, insured’s/customers/ agents or attorney of denial of claim when applicable.
- May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and 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 benefits timely and appropriately. Maintains control of claim’s resolution process to minimize current exposure and future risks
- Establishes and maintains strong customer relations i.e. agents, underwriters, insureds, 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.