ESIS Claims Representative, WC
ESIS Claims Representative, WC
Posted on :
24-07-2025
Employer Active
1 Vacancy
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Job Description
Description
Qualifications
The WC Claim Representative under the direction of the Claims Team Leader investigates and settles claims promptly equitably and within established best practices guidelines.
MAJOR DUTIES & RESPONSIBILITIES:
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.
- Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.
- 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 proofs of loss or compensation agreements and issues company drafts in payments for claims.
- 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 arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial.
- Refers claims to subrogation as appropriate. May arrange for salvage disposition or other recovery proceedings as necessary by line of business.
- May participate in claim file reviews and audits with customer/insured and broker. Administers benefits timely and appropriately. Maintains control of claims resolution process to minimize current exposure and future risks
- Establishes and maintains strong customer relations
Depending on line of business other duties may include:
- Maintaining system logs
- Investigating compensability and benefit entitlement
- Reviewing and approving medical bill payments
- Managing vocational rehabilitation
Qualifications
- 1-2 years experience handling claims in a relevant line of business.
- Basic 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
- Knowledge of company products services coverages and policy limits along with awareness of the companys claims best practices
- Knowledge of applicable state and local laws
Required Experience:
Unclear Seniority
Employment Type
Full-Time
Key Skills
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