ESIS WC Sr Claims Representative
Under the direction of the Claims Team Leader investigates and settles claims promptly, equitably and within established best practices guidelines.
MAJOR DUTIES & RESPONSIBILITIES:
Duties include but are not limited to:
• Under limited supervision, Receives assignments and reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
• Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
• Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.
• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.
• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
• Sets reserves within authority limits and recommends reserve changes to Team Leader.
• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
• Prepares and submits to Team Leader unusual or possible undesirable exposures.
• Assists Team Leader in developing methods and improvements for handling claims.
• Settles claims promptly and equitably.
• Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
• Informs claimants, insureds/customers or attorney of denial of claim when applicable.
The ACE Group is one of the world’s largest multiline property and casualty insurers. With operations in 53 countries, ACE provides...