
ESIS ProClaim Specialist
- Melville, NY
- $71,900-134,700 per year
- Permanent
- Full-time
- Determine coverage, conducts 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.
- Posts loss and expense reserves in Claims system within authority limits and recommends reserve changes above authority to AVP and/or VP of Claims.
- Reviews progress and status of claims with claims leadership and discusses issues/opportunities/task and remedial actions.
- Prepares and submits to claims leadership all unusual or potentially undesirable exposures such as allegations of bad faith or unfair claim practice allegations.
- Assists Claims Leadership in formulating improvements in claims handling procedures.
- Assist and works with Partnership Leaders on delivering results, attend meetings and claim reviews.
- Reviews and confirms claims professionals have secured the appropriate releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
- Maintains claims with the appropriate file notes, reports, photos, and documentation within the claim.
- Follows all company and regulatory compliance requirements.
- Updates claim timely with Medicare data and addresses Medicare reporting & interest.
- 10 or more years of experience as a claim professional and/or claims management with a high degree of specialized and technical competence in the handling of environmental/asbestos/mass tort and other complex professional and general liability claims with emphasis on hands-on file and litigation management.
- P&C insurance adjuster license where required.
- Knowledge of insurance industry and claims handling concepts, practices, and procedures.
- Strong background and demonstrated ability in dealing with significant coverage matters.
- An understanding of insurance and legal principles.
- Knowledge of P&C Group coverage and services.
- Working knowledge of industry best practices and procedures.
- An ability to work independently.
- Excellent interpersonal communications and negotiation skills and an ability to deal with customers and business partners in a professional manner.
- Ability to make prompt, reasoned decisions based upon detailed analysis of complex issues.
- Bachelor's Degree or higher.