ESIS ProClaim Senior Specialist

- Senior

Simsbury, CT

Insurance Carriers and Related Activities

About the position

ESIS ProClaim is seeking an experienced Senior Claims Specialist. Under the direction of the AVP and VP of Claims and Claims Team Leader, you will review coverage, investigate facts of third-party property claims, secure evidence, assess and address subrogation/recovery/tenders, apportion liability and settle claims at the best outcome within established claim best practices guidelines and client instructions.

Responsibilities

• Determine coverage, conduct 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.
• Post loss and expense reserves in Claims system within authority limits and recommend reserve changes above authority to AVP and/or VP of Claims.
• Review progress and status of claims with claims leadership and discuss issues/opportunities/task and remedial actions.
• Prepare and submit to claims leadership all unusual or potentially undesirable exposures such as allegations of bad faith or unfair claim practice allegations.
• Assist Claims Leadership in formulating improvements in claims handling procedures.
• Assist and work with Partnership Leaders on delivering results, attend meetings and claim reviews.
• Review and confirm claims professionals have secured the appropriate releases, proofs of loss or compensation agreements and issue company drafts in payments for claims.
• Maintain claims with the appropriate file notes, reports, photos, and documentation within the claim.
• Follow all company and regulatory compliance requirements.
• Update claim timely with Medicare data and address Medicare reporting & interest.
• Meet or exceed performance goals.