Description

• Receive assignments and review claim and policy information to support investigations and determine the extent of policy obligations based on the line of business, under close supervision.
• Supervise claim representatives in the handling of claims for assigned accounts.
• Review insurance policies to confirm coverage and ensure timely reporting to applicable primary, excess, or reinsurers.
• Maintain a diary system to ensure each file is reviewed at least every 90 days.
• Attend monthly and/or quarterly claims committee meetings and present cases in detail to support informed client decisions regarding strategy and reserving.
• Apply company-approved best practices to each file to support timely and effective claims management; ensure each file includes a completed case strategy summary and disposition plan.
• Monitor defense counsel to ensure compliance with reporting requirements from clients and ESIS Specialty.
• Contact, interview, and obtain statements from insured parties, claimants, witnesses, medical professionals, attorneys, police officers, and others to gather necessary claim information.
• Prepare reports on investigations, settlements, claim denials, and evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader and client.
• Review and process defense counsel and third-party invoices promptly to support timely payment.
• Review claim progress and status with the Team Leader, discuss challenges, and recommend solutions.
• Settle claims promptly and equitably.
• Obtain releases, proofs of loss, or compensation agreements and issue claim payments.
• Communicate claim denials to claimants, insured parties, or attorneys when applicable.
• Support the marketing team as new opportunities arise.