ESIS Senior Claims Representative, WC
ESIS Senior Claims Representative, WC
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Job Description
Are you ready to make a meaningful impact in the world of workers compensation Join ESIS a leader in risk management and insurance services where your skills and talents can help us create safer workplaces and support employees during their times of need. At ESIS were dedicated to providing exceptional service and innovative solutions and were looking for passionate individuals to be part of our dynamic team. If youre eager to advance your career in a collaborative environment that values integrity and growth explore our exciting workers compensation roles today and discover how you can contribute to a brighter future for employees everywhere!
The Workers Compensation Senior Claims Representative Pension Desk 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.
- 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 and timely issues indemnity benefits if due and owing.
- 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 taking statements. Continues efforts to settle claims before trial.
- Refers claims to subrogation as appropriate.
- May participate in claim file reviews and audits with customer/insured and broker. Administers Workers Compensation benefits timely and appropriately per Jurisdiction. Maintains control of claims resolution process to minimize current exposure and future risks
- Establishes and maintains strong customer relations
OTHER DUTIES MAY INCLUDE:
- Working all queues and diary in a timely manner
- Investigating compensability and benefit entitlement
- Reviewing and approving medical bill payments
- Managing vocational rehabilitation
Qualifications
- 5-7 years experience handling Workers Compensation claims
- 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 etc. in a positive manner concerning losses.
- Ability to self-motivate and work independently excels in organization and time management skills
- Knowledge of company products services coverages and policy limits along with awareness of the companys claims best practices and client service instructions
- Knowledge of applicable state and local laws.
An applicable resident or designated home state adjusters license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESISs 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 multi-line Third-Party Administrator (TPA) provides claims risk control & loss information systems toFortune 1000 clients across its North American a full range of sophisticated risk management services including workers compensation claims handling; a broad spectrum of casualty insurance products such as general liability automobile liability products liability professional liability and medical malpractice claims handling; and disability management.
Required Experience:
Senior IC
Employment Type
Full-Time
