ESIS ProClaims Manager, A&H

ESIS ProClaim A&H is currently seeking an experienced Claims professional to supervise and guide the activities of Claims Representatives in the investigation and settlement of claims to assure prompt, efficient and fair claims services. 

Key Objective

Under the direction of the AVP of Claims, the Claims Team Leader will work with their direct reports in all aspects of third-party claim management. The Claims Team Leader will work closely with their direct reports and will be involved in various tasks such as assigning new claims, investigating coverage, examining the facts of third-party claims, handling subrogation and recovery, determining liability, and settling claims in line with established best practices and client instructions. Additionally, the Claims Team Leader will also provide assistance, guidance, and development opportunities to the team. 

Duties include but are not limited to: 

• Supervise a claims team of professionals.
• Assign new claims with direction to the claims professional addressing: policy information 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.
• Provides coaching and feedback to their direct reports.
• Develops, works, and shares performance and productivity goals.
• Reviews, analyzes, and shares performance results, productivity, and audit/quality review results.
• Works with assigned claims professionals to insure detailed 90-day Claim Summary Reports are prepared and provide updates to the client on investigation, potential settlement opportunities, claim denials, reservation of rights, 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.

• 5 or more years of experience as a claims professional and/or claims management with a high degree of specialized and technical competence in the handling of Accident and Health or Travel claims.  
• 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 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.
• 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.

The pay range for the role is $71,500 to $115,000. 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.

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 liabili