- Determine coverage, conducts a thorough investigation and may determine the extent of the policy's obligation to the insured depending on the line of business.
- Maintain diary system to ensure each file is reviewed at a minimum of every 90 days.
- Effectively work with defense counsel and litigation working collaboratively, as directed by the client.
- Ensure detailed 90-day Claim Summary Reports are prepared and provide updates to the client on investigation, potential settlement opportunities, claim denials, reservation of rights, third party tenders and recommendations to present at claims review meetings.
- Posts loss and expense reserves in Claims system within authority limits and recommends reserve changes above authority to AVP and/or VP of Claims.
- Reviews progress and status of claims with claims leadership and discusses issues/opportunities/task and remedial actions.
- Prepares and submits to claims leadership all unusual or potentially undesirable exposures such as allegations of bad faith or unfair claim practice allegations.
- Assists Claims Leadership in formulating improvements in claims handling procedures.
- Assist and works with Partnership Leaders on delivering results, attend meetings and claim reviews.
- Reviews and confirms claims professionals have secured the appropriate releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
- Maintains claims with the appropriate file notes, reports, photos, and documentation within the claim.
- Follows all company and regulatory compliance requirements.
- Updates claim timely with Medicare data and addresses Medicare reporting & interest.
- Meets or exceeds performance goals.
- 10 or more years of experience as a claim professional and/or claims management with a high degree of specialized and technical competence in the handling of professional and general liability claims with emphasis on hands-on file and litigation management.
- P&C insurance adjuster license where required.
- 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 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.
- Excellent interpersonal communications and negotiation skills and an ability to deal with customers and business partners in a professional manner.
- Ability to make prompt, reasoned decisions based upon detailed analysis of complex issues.
- Bachelor's Degree or higher.
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ESIS ProClaim Senior Representative - Overland Park, United States - Chubb
Description
Job DescriptionESIS, 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 70 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.
ESIS Specialty is a results oriented TPA owned by ESIS/Chubb Insurance. We continually monitor, measure, and analyze trends while working closely with our clients to identify opportunities to positively impact their program costs ESIS Specialty applies a balanced approach to claims handling and management and continually refines our approach to be sure our services are customized, complementary and complete.
ESIS ProClaim is seeking an experienced Senior Claims Representative. In this role you will manage complex claims professional liability and general liability claims and other lines.
Key Objective
Under the direction of the AVP and VP of Claims and Claims Team Leader you will review coverage, investigates facts of third-party claims, secure evidence, assesses, addresses subrogation/recovery/tenders, and apportions liability and settles claims at the best outcome within established claim best practices guidelines and client instructions.
Duties include but are not limited to:
Desired Qualifications:
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.
