ESIS Claims Representative, AGL

JOB DESCRIPTION Manage Auto Liability matters * 1st Party Claims + Interpret appropriate policy to determine coverage + PIP (Med pay), UIM, UM claims + Recommend when IME's would be need. When approved coordinate IME's through vendor + Determine if Medical billing is related to claimed injuries + Speak with claimant related to treatment plans and recommend case management when necessary + Mail all medical bills to vendor to have them looked at for relevancy and fair and customary billing amounts + Payment of appropriate medical bills + Determine reportable files per agreement with insurance company and give claim status reports to insurance company + ORM Reporting o Determining what claims with ongoing responsibility for medical. o Explain why claims need to be reported based on particular no-fault status + MCCA o Submit reimbursement requests o Determine if certain expenses need prior MCCA approval for payment and seek approval if needed o Provide semiannual claim status reports * 3rd Party Claims + All US claims for bodily injury and property damage (except for MI Mini Tort) + Determine if claims can be tendered to events or TNC if indemnity agreement exists + Gather claim information + Determine liability based on facts available and applicable state law + Assign appraisers when necessary, through Audatex system + Review repair estimates and determine if appraisal is needed + Review medical documentation for bodily injury claims + Work with ESIS Total Loss Team for total loss of 3rd party vehicles + Negotiate claims with plaintiff counsel or claimant directly for BI and PD claims QUALIFICATIONS * Bachelor's degree in business, nursing, paralegal studies, or criminal justice is preferred. * 1 to 3 years of general claims adjusting or auto liability experience. * Background in medical billing, healthcare, or legal/paralegal environments. * State Adjuster License (Resident or Designated Home State/Non-Resident reciprocal license). * Statutory knowledge of state-specific auto laws, tort thresholds, and mandatory PIP/no-fault regulations. * Familiarity with case law, statute of limitations, and binding arbitration or litigation procedures. An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam. ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS' innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients' unique risk management needs. With more than 70 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry's broadest selections of risk management solutions covering both pre- and post-loss services. ABOUT US Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.