Key Objective
This role focuses on the technical handling of Auto, Property, General Liability, and Professional Liability claims across multiple jurisdictions. The position is responsible for managing all aspects of claims, including investigation, coverage determination, reserving, negotiation, settlement, and overall claim strategy. Travel may be required. The role also includes representing the company in meetings with management, business partners, and other claim-related stakeholders.
Major Duties & Responsibilities
- 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.
