ESIS Senior Claims Representative, WC
Locations: New York, NY | Cheektowaga, NY

Work Arrangement
This role follows a hybrid schedule of 3 days in office and 2 day remote.

Key Objective
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.
• Review claim and policy information to provide background for investigation and determine the extent of the policy's obligation to the insured, depending on the line of business.
• Contact, interview, and obtain statements, recorded or in person, from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to secure necessary claim information.
• Arrange for surveys and experts where appropriate.
• Evaluate facts supplied by investigation to determine the extent of liability of the insured, if any, and the company's obligation to the insured under the policy contract.
• Prepare reports on investigations, 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.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and improvements for handling claims.
• Settle claims promptly and equitably.
• Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
• Inform claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and taking statements; 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 benefits timely and appropriately.
• Maintain control of the claim resolution process to minimize current exposure and future risks.
• Establish and maintain strong customer relations with agents, underwriters, insureds, and experts.

• Maintain system logs.
• Investigate compensability and benefit entitlement.
• Review and approve medical bill payments or forward for outside review as necessary.
• Manage vocational rehabilitation.

QUALIFICATIONS

What You'll Need

• Four-year college degree and/or equivalent work experience; additional degrees such as an MBA preferred.
• Strong technical claims knowledge and competence in Workers' Compensation claims, demonstrated through claims handling experience at ESIS or a similar organization, preferably 5 years of experience.
• Thorough knowledge of Workers' Compensation products, services, and coverages, along with a solid understanding of applicable legal principles.
• Knowledge of WC cost containment programs and proven account management skills.
• Insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), AICPCU, or similar preferred.
• Ability to plan, organize, and implement general business and people management practices, supported by management and technical training, a business or legal college curriculum, or equivalent practical experience.
• Strong communication and interpersonal skills with the ability to work effectively with subordinates, all levels of ESIS personnel, attorneys, producers, and accounts.
• Understanding of team-building theory and how it applies to ongoing and planned activities.
• Ability to evaluate the effectiveness of programs and procedures and recommend improvements; able to facilitate and lead groups.
• Strong evaluative thinking, with the ability to gather and consider multiple sources of data to form conclusions and determine courses of action.
• Demonstrated personal effectiveness, including confidence, credibility, and commitment to established strategies and values.
• Creativity and self-motivation demonstrated through direct claim handling and related functions.
• Ability to manage activities and resource allocation with a focus on timely, high-quality service and long-term value in claims handling.

An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.

ESIS, a multi-line Third-Party Administrator (TPA), provides claims, risk control & loss information systems to Fortune 1000 clients across its North American platform. ESIS provides a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products, such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management.

The pay range for the role is $71,000 to $104,00. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.

ABOUT US

Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally.

At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.