Senior Claim Specialist Position - Professional Liability
ESIS ProClaim is a national professional and specialty lines Third Party Administrator (“TPA”) wholly owned by ESIS, Inc. and a subsidiary of Chubb Insurance. We are considered as an industry leader handling claims administration and risk consulting for Fortune 1000 Self-Insured’s, Captives, Risk Retention Groups and MGA Programs. We are ranked nationally as a “Top 3” Professional Lines TPA. Our objective is to deliver a superior customer experience while identifying opportunities to drive down our clients total cost of risk. ESIS ProClaim applies a balanced approach to claims handling and management and continually refines our approach to be sure our services are customized, complementary and complete.
This role is focused on the technical claim handling of Professional Liability. In this role you will manage claims and litigation in multiple jurisdictions. You will be accountable for the handling and disposition of claims including investigation, coverage determination, reserving, negotiation and settlement and overall claim strategy. The position may require travel. You will represent the company at meetings with clients, management, business partners and in other claim related activities.
MAJOR DUTIES & RESPONSIBILITIES:
Duties include but are not limited to:
Qualifications - External
- Under close supervision, receives assignments and 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, healthcare providers, attorneys, police officers, etc. to secure necessary claim information.
- 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.
- Settles claims promptly and equitably.
- Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
- Informs claimants, insureds/customers or plaintiff attorney of denial of claim when applicable.
- 10 or more years of experience as a claims professional with a high degree of specialized and technical competence in the handling of high exposure claims with emphasis on hands-on file and litigation management.
- P&C insurance adjuster license
- J.D., R.N., or CPCU designation a plus
- Professional Liability (PL) and General Liability (GL) with experience in PL Bodily Injury and GL Products & Premises Liability.
- Knowledge of insurance industry and claims handling concepts, practices, and procedures
- Strong background and demonstrated ability in dealing with significant coverage matters.
- An understanding of the tenants of insurance and legal principles.
- Knowledge of P&C Group coverage and services.
- Working knowledge of industry best practices and procedures.
- An ability to work independently and assimilate learning materials on many different subjects from various sources.
- Excellent interpersonal communications and negotiation skills; and an ability to deal with customers and business partners in a professional manner.
- Ability to make prompt, intelligent decisions based upon detailed analysis of complex issues.
- Demonstrated strong relational skills particularly in adverse or high-pressure situations.
ESIS ProClaim offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, a retirement savings plan, disability coverage, stock purchase plan, flexible spending accounts, tuition reimbursement, and business casual dress. ESIS ProClaim is an equal opportunity employer and our employment decisions are made without regard to race, color, religion, age, gender, national origin, disability, handicap, marital status or any other status or condition protected by Federal and/or State laws, except where bona fide occupational qualifications apply.