ESIS Claims Team Leader, AGL

JOB DESCRIPTION

GENERAL RESPONSIBILITIES:


* Improve the technical quality of files within the team.


* Act as a team facilitator to help remove barriers and take an active role in resolving team issues.


* Be an integral member of the Claims Office Management Team.


* Be responsible for ongoing team development, ensuring effective loss dollar management, and providing value-added customer service.


* Maintain a strong commitment to team building and ESIS management principles.


* Understand and utilize current information systems.


* Collect and analyze data to identify individual opportunities for improvement.


* Work with individuals to assess their knowledge and skill gaps and develop plans for enhancement.


* Promote ESIS Claims Management Division strategies and values.


* Address Human Resource issues and problems effectively.


* Demonstrate a proactive approach to servicing external and internal customers.


* Show understanding and ability to apply the technical aspects of claims handling.


* Provide one-on-one coaching and counseling to team members.


* Effectively evaluate programs and procedures for continuous improvement.

SPECIFIC RESPONSIBILITIES:


* Review and assign all new claims based on customer needs and claim complexity.


* Determine initial reserves and provide direction to representatives as needed.


* Ensure that all coding and documentation are appropriate.


* Follow files according to diaries established by the system as well as individual claim file diaries based on the complexity of the file or customer agreements.


* Review files at key checkpoints for coverage, investigation, subrogation, reserve accuracy, fraud indicators, and provide guidance on ESIS best practices as well as account and carrier requirements.


* Participate in account discussions regarding file issues if they escalate beyond the representative.


* Review status reports for accounts as needed and participate in file reviews as required.


* Manage overall performance for team members, including attendance, file quality, service, and interpersonal issues.


* Ensure reserve adequacy in compliance with ESIS and carrier requirements.


* Participate in litigation strategy sessions.


* Participate in the strategy and management of catastrophic injuries, collaborating with clients, brokers, counsel, representatives, claims vice presidents, home office, carriers, etc.


* Conduct quality audits in addition to individual claim file reviews.


* Provide feedback and responses to carrier, customer, and broker reviews.


* Coordinate training for the team and often for the office on jurisdictional, procedural, carrier requirement, and account requirement topics.


* Resolve concerns from customers, claimants, brokers, or carriers if they escalate beyond the representative.


* Balance caseloads of representatives within the team and across the o...