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ESIS ProClaim Senior Specialist

4 months ago

Melville, United States Chubb Full time

ESIS ProClaim is seeking an experienced Claims Specialist. In this role you will manage general liability and professional 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:

* 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.