ESIS ProClaim Senior Representative, A&H

The Accident & Health and Travel Adjuster is responsible for the day-to-day management of an inventory of travel, hospital indemnity, hospital accident, and accidental death and dismemberment claims. This role reviews medical and travel documentation, investigates losses, interprets policy language to determine coverage and payment, evaluates and updates 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 prioritization skills, the ability to manage multiple priorities, adaptability, and the ability to meet claim handling requirements and industry best practices in a fast-paced, changing environment.

This position requires in-office work a minimum of three days per week.

Position Responsibilities

Duties include, but are not limited to:

• Reviews claim and policy information to support investigations and determine the company’s obligation to the insured, based on the line of business.
• Contacts and interviews insureds, claimants, witnesses, physicians, attorneys, police officers, and other relevant parties to obtain information needed to evaluate claims.
• Assesses travel-related losses, including trip cancellation, trip interruption, medical emergencies, baggage loss, travel delays, and other covered events.
• Evaluates facts gathered through investigation to determine liability and the company’s obligation under the policy contract.
• Prepares reports related to investigations, settlements, claim denials, and evaluations of involved parties.
• Maintains detailed claim notes, accurate documentation, and complete file records.
• Responds to customer inquiries professionally and provides clear status updates.
• Ensures timely claim handling in accordance with service standards and regulatory requirements.
• Establishes reserves within authority limits and recommends reserve changes to the Team Leader.
• Reviews claim progress with the Team Leader and discusses issues and recommended actions.
• Identifies unusual or potentially adverse exposures and escalates them to the Team Leader as needed.
• Supports the Team Leader in developing improved claims handling methods and processes.
• Settles claims promptly and equitably.
• Obtains releases, proofs of loss, or compensation agreements and issues claim payments.
• Identifies potential fraud indicators and escalates suspicious claims when appropriate.
• Communicates claim outcomes to claimants, insureds, customers, or attorneys.
• Supports quality, compliance, and continuous improvement efforts in claims handling.

• Strong time management skills and the ability to work independently
• Proficiency with Microsoft Office applications, including Excel, Word, and PowerPoint
• Strong written communication skills, with the ability to document policy interpretation clearly and accurately
• Strong customer service skills
• Experience using claims handling systems
• Adjuster licensing preferred
• Claims handling experience preferred
• Ability to work collaboratively in a team environment and adapt to changing priorities and circumstances

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.