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ESIS - WC Claims Team Leader in Cheektowaga, NY at Chubb Group of Insurance Companies

Date Posted: 10/14/2018

Job Snapshot

Job Description

W.C. Claims Supervisor
General Responsibilities:
• Improve the technical file quality of files within the team.
• Act as a team facilitator to help remove team barriers and take an active role in the resolution of team issues.
• Be an integral member of the Claims Office WC Management Team.
• Be responsible for ongoing team development, ensuring loss dollar management, and provide value-added customer service.
• Have an understanding commitment to Team Building and ESIS management principles.
• Have the ability to understand and utilize current information systems (i.e., Risk Advantage, Measures & Monitors, e-Desk etc.).
• Be able to collect and analyze data to identify individual opportunities for improvement.
• Work with individuals to assess their knowledge and skill issues and develop plans for improvement.
• Act to promote ESIS Claims Management Division strategies and values.
• Have ability to understand and address Human Resource issues and problems.
• Demonstrate a proactive approach to service to external and internal customers.
• Have an understanding and demonstrated ability to apply the technical aspects of claim handling.
• Be able to provide one-on-one coaching and counseling.
• Be able to effectively evaluate programs and procedures for continuous improvements.
Specific Responsibilities:
  • Review and assign all new claims based on customer & complexity.
  • Determine initial reserves and provide initial direction to reps who may need direction (depends on experience) identify issues with compensability, medical conditions, subrogation, etc.
  • Make sure all coding, etc is appropriate.
  • Follows files on diaries established by the system as well as individual claim file diaries based on complexity of the file or customer agreements. 
  • Reviews files at these ‘checkpoints’ for investigation, medical management, subrogation, statutory requirements (forms, etc) reviews accuracy of reserves, looks for fraud indicators, and provides direction for a myriad of ESIS best practices as well as account and carrier requirements.
  • Gets involved on account discussions with file issues if issues elevate beyond the rep.
  • Review status reports for accounts as needed and participate in file reviews as needed.
  • Manage overall performance for individuals in the team… attendance, file quality, service, interpersonal issues. 
  • Responsible for reserve adequacy in compliance with ESIS AND carrier requirements.
  • Participate in litigation strategy sessions.
  • Review and correct (sometimes completing themselves) a plethora of internal documents for a variety of items (reserves, appeals, internal audit requirements, SAS 70, etc.)
  • Participate in strategy and management of catastrophic injuries with account, nurse, rep, claim vp, home office, carrier, etc.
  • Complete quality audits in addition to individual claim file reviews. 
Qualifications include:
• Four-year college degree and/or equivalent work experience or additional degrees (ex. MBA)
• High level of technical claims knowledge and competence in Workers' Comp claims, as evidenced by demonstrated claims handling experience at ESIS (preferably 5 years claims handling experience), or within a similar organization.
• Thorough knowledge of Workers' Compensation products, services, and coverages, along with a good understanding of applicable legal principles.
• Knowledge of WC cost containment programs and proven account management skills a must.
• Insurance Designations such as Associate in Claims (AIC), Associate in Risk Mgt (ARM), AICPCU, etc.
• Ability to plan, organize and implement general business and people management practices, as evidenced by successful completion of Management and Technical Programs, completion of a business or legal college level curriculum, or equivalent related practical work experience.
• Demonstrated effective communication and interpersonal skills to be capable of dealing with subordinates, all levels of ESIS personnel, as well as attorneys, producers, and accounts.
• Demonstrated understanding of the team building theory and how it applies to on going and planned activities.
• Ability to evaluate the effectiveness of various programs and procedures and incorporate improvements. Ability to facilitate and lead group(s) of people.
• Demonstrated evaluative thinking with evidence of seeking out and considering multiple sources of data to form conclusions and determine courses of action.
• Evidence of strengthening personal effectiveness by demonstrating confidence, credibility and commitment to established strategies, and values.
• Demonstrated creativity and self motivation in present position and activities through action and involvement in direct claim handling and other related functions.
• Evidence of the ability to intellectually manage activities and resource allocation issues that are driven by such things as timely, high quality service, and longer term payback opportunities related to claims handling processing.

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