Senior Claims Representative - Workers’ Compensation

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

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.

Additional Duties Depending on Line of Business

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

Scope Information
The position reports directly to a Claims Team Leader or other member of claims management.

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.

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.

• Review claim and policy information to assess liability and policy obligations.
• Conduct interviews and obtain statements from insureds, claimants, witnesses, physicians, attorneys, and law enforcement.
• Arrange surveys, expert evaluations, and manage necessary investigations.
• Evaluate investigation findings, set and adjust reserves within authority limits, and recommend changes to Team Leader.
• Prepare detailed investigation and settlement reports, including denial justifications.
• Manage litigation files, assist attorneys with trial preparation, and pursue settlement before trial.
• Issue releases, proofs of loss, and draft payment checks for claims and expenses.
• Communicate claim decisions to claimants, insureds, agents, and attorneys promptly.
• Coordinate subrogation referrals and participate in claim audits with brokers and insureds.
• Maintain strong relationships with agents, underwriters, experts, and customers while ensuring timely benefit administration.