ESIS Claims Team Leader, WC

KEY OBJECTIVE:

Supervises and directs the activities of Claims Representatives in the investigation and settlement of claims to assure prompt, efficient and fair claims services.

MAJOR DUTIES & RESPONSIBILITIES:

• Reviews initial notice of claim, determines extent and validity of coverage, and screens for qualification for flow process. Determines measures to be taken in absence of coverage or questionable cases.

• Assigns work to subordinate Claims Representatives. Determines and delegates settlement authority to Claims Reps, in conjunction with Claim Vice President or Unit Manager. Retains higher settlement authority beyond scope of subordinates; may directly settle such cases. Refers cases beyond scope of authority to Unit Managers.

• Supervises investigations, and oversees settlement or disposition of claims by assuring prompt contact of insureds and claimants, timely investigation, and equitable settlement.

• Establishes loss reserves to reflect probable Company obligation; and reviews and modifies reserves as necessary.

• May directly settle claims, depending on office size, territory, and workload. Evaluates work of subordinate Claims Reps on open cases, or at periodic intervals. Provides direction and counsel by identifying areas of improvement needed.

• Initiates proceedings for subrogation or recovery. On cases in suit, contacts and directs the activities of Claims Attorney. Negotiates and authorizes settlement.

• Participates in human resources processes affecting subordinates in assigned unit, conducts Performance Evaluations, implements training and development. Participates in salary administration process. Responsible for recruitment and staffing of unit as vacancies occur.