Manage Auto Liability matters
1st Party Claims
Interpret appropriate policy to determine coverage
PIP (Med pay), UIM, UM claims
Recommend when IME’s would be need. When approved coordinate IME’s through vendor
Determine if Medical billing is related to claimed injuries
Speak with claimant related to treatment plans and recommend case management when necessary
Mail all medical bills to vendor to have them looked at for relevancy and fair and customary billing amounts
Payment of appropriate medical bills
Determine reportable files per agreement with insurance company and give claim status reports to insurance company
ORM Reporting
Determining what claims with ongoing responsibility for medical.
Explain why claims need to be reported based on particular no-fault status
MCCA
Submit reimbursement requests
Determine if certain expenses need prior MCCA approval for payment and seek approval if needed
Provide semiannual claim status reports
3rd Party Claims
All US claims for bodily injury and property damage (except for MI Mini Tort)
Determine if claims can be tendered to events or TNC if indemnity agreement exists
Gather claim information
Determine liability based on facts available and applicable state law
Assign appraisers when necessary, through Audatex system
Review repair estimates and determine if appraisal is needed
Review medical documentation for bodily injury claims
Work with ESIS Total Loss Team for total loss of 3rd party vehicles
Negotiate claims with plaintiff counsel or claimant directly for BI and PD claims
- Bachelor's degree in business, nursing, paralegal studies, or criminal justice is preferred.
- 1 to 3 years of general claims adjusting or auto liability experience.
- Background in medical billing, healthcare, or legal/paralegal environments.
- State Adjuster License (Resident or Designated Home State/Non-Resident reciprocal license).
Statutory knowledge of state-specific auto laws, tort thresholds, and mandatory PIP/no-fault regulations.
Familiarity with case law, statute of limitations, and binding arbitration or litigation procedures.
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.