Description

JOB DESCRIPTION

ESIS ProClaim A&H is seeking an experienced claims professional to supervise and guide a team of Claims Representatives, ensuring prompt, efficient, and fair claims services.

Key Objective:
Reporting to the AVP of Claims, the Claims Team Leader supports all aspects of third-party claim management. This role involves assigning new claims, investigating coverage, examining third-party claims, managing subrogation and recovery, determining liability, and settling claims in accordance with established best practices and client instructions. The Claims Team Leader also provides coaching, guidance, and development opportunities to the team.

Key Responsibilities:

• Supervise and support a team of claims professionals.
• Assign new claims and provide direction on policy coverage, thorough investigation, and determination of the company's obligation to the insured, based on the line of business.
• Maintain a diary system to ensure each file is reviewed at least every 90 days.
• Provide ongoing coaching and constructive feedback to direct reports.
• Develop, monitor, and communicate performance and productivity goals.
• Review, analyze, and share performance results, productivity data, and audit/quality review outcomes.
• Ensure detailed 90-day Claim Summary Reports are prepared and provide client updates on investigations, settlement opportunities, claim denials, reservation of rights, and recommendations for claims review meetings.
• Post loss and expense reserves within authority limits and recommend reserve changes above authority to the AVP and/or VP of Claims.
• Review claim progress and status with claims leadership, discussing issues, opportunities, and remedial actions.
• Prepare and submit reports on unusual or potentially undesirable exposures, such as allegations of bad faith or unfair claim practices, to claims leadership.
• Assist claims leadership in developing improvements to claims handling procedures.
• Collaborate with Partnership Leaders to deliver results, attend meetings, and participate in claim reviews.
• Ensure claims professionals obtain appropriate releases, proofs of loss, or compensation agreements, and issue company payments for claims.
• Maintain accurate and complete claim files, including notes, reports, photos, and documentation.
• Adhere to all company policies and regulatory compliance requirements.

Requisition #: 31060

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