About this role
The Accident and Health Adjuster is responsible for the day-to-day management of a claim inventory involving hospital indemnity, hospital accident, and accidental death and dismemberment claims. This role reviews medical documentation, investigates losses, interprets policy language to determine coverage and payment, establishes and evaluates reserves, prepares coverage letters and reports, and delivers high-quality customer service.
This position reports to the Team Leader. The selected candidate should demonstrate initiative, strong organizational skills, the ability to prioritize multiple tasks, adaptability, and the ability to work effectively in a fast-paced, changing environment while meeting industry best practices and claim handling requirements.
The selected candidate will be required to work in the office a minimum of three days per week.
Position Responsibilities
Duties include, but are not limited to:
- Under limited supervision, receives assignments and reviews claim and policy information to support the investigation and determine the extent of the policy’s 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, and others to gather necessary claim information.
- Depending on the line of business, inspects and appraises damage for property losses or arranges for such appraisal.
- Evaluates facts gathered through investigation to determine the extent of liability, if any, and the company’s obligation to the insured under the policy contract.
- Prepares reports related to investigations, settlements, claim denials, and evaluations of involved parties.
- Establishes reserves within authority limits and recommends reserve changes to the Team Leader.
- Reviews claim progress and status with the Team Leader and discusses issues and recommended corrective actions.
- Submits unusual or potentially adverse exposures to the Team Leader for review.
- Assists the Team Leader in developing methods and process improvements for claims handling.
- Settles claims promptly and fairly.
- Obtains releases, proofs of loss, or compensation agreements and issues company drafts for claim payments.
- Informs claimants, insureds/customers, or attorneys of claim denials when applicable.
- Strong project management skills and the ability to work independently
- Proficiency with Microsoft Office applications, including Excel, Word, and PowerPoint
- Strong written communication skills, including the ability to document policy interpretation clearly
- Strong customer service skills
- Experience using claims handling systems
- Adjuster licensing preferred
- Claims handling experience preferred
- Ability to work collaboratively, adapt to changing priorities, and contribute positively to a team environment
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.
ESIS Specialty continually monitors, measures, and analyzes trends while working closely with clients to identify opportunities to positively impact their program costs. ESIS Specialty applies a balanced approach to claims handling and management and continually refines approach to be sure services are customized, complementary and complete.
The pay range for the role is $78,000 to $112,000. The specific offer will depend on an applicant’s skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website . The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.