ESIS Claims Specialist, AGL

The AGL Claims Specialist: Under the direction of the Claims Team Leader investigates and settles claims promptly equitably and within established best practices guidelines.

Duties may include but are not limited to:

• Receive assignments.
• Reviews claim and policy information to provide background for investigation and may determine the extent of the policys obligation to the insured depending on the line of business.
• Contacts interviews and obtains statements (recorded or in person) from insureds claimants witnesses physicians attorneys police officers etc. to secure necessary claim information.
• Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.
• Evaluates facts supplied by investigation to determine extent of liability of the insured if any and extend of the companys obligation to the insured under the policy contract.
• Prepares reports on investigation settlements denials of claims individual evaluation of involved parties etc.
• Sets reserves within authority limits and recommends reserve changes to Team Leader.
• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
• Prepares and submits to Team Leader unusual or possible undesirable exposures. Assists Team Leader in developing methods and improvements for handling claims.
• Settles claims promptly and equitably.
• Obtains releases proofs of loss or compensation agreements and issues company drafts in payments for claims.
• Informs claimants insureds/customers or attorney of denial of claim when applicable.
• May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial.
• Refers claims to subrogation as appropriate. May arrange for salvage disposition or other recovery proceedings as necessary by line of business.
• May participate in claim file reviews and audits with customer/insured and broker. Administers benefits timely and appropriately. Maintains control of claims resolution process to minimize current exposure and future risks

• Establishes and maintains strong customer relations

Depending on line of business other duties may include:

• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments
• Managing vocational rehabilitation

• College degree or 7 years experience handling claims in a relevant line of business including Construction Defect claims.
• Basic knowledge of claims handling and familiarity with claims terminologies
• Effective negotiation skills
• Strong communication and interpersonal skills to be capable of dealing with claimants customers insureds brokers attorneys a positive manner concerning losses.
• Ability to self-motivate and work independently
• Knowledge of company products services coverage and policy limits along with awareness of the companys claims best practices
• Knowledge of applicable state and local lawsand ability to obtain necessary license