ESIS Claims Representative, Defense Based ActLongshore

ESIS Claims Representative Defense Based Act/Longshore

Location: Tampa Florida

• Under close supervision receive assignments and review 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.
• Contact interview and obtain statements (recorded or in person) from insureds claimants witnesses physicians attorneys police officers etc. to secure necessary claim information.
• Evaluate facts supplied by the investigation to determine the extent of liability of the insured if any and the extent of the companys obligation to the insured under the policy contract.
• Prepare reports on investigations settlements denials of claims and individual evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader.
• Review progress and status of claims with the Team Leader and discuss problems and suggested remedial actions.
• Prepare and submit to the Team Leader any unusual or potentially undesirable exposures.
• Assist the Team Leader in developing methods and improvements for handling claims.
• Settle claims promptly and equitably.
• Obtain releases proofs of loss or compensation agreements and issue company drafts for payments on claims.
• Inform claimants insureds/customers or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial by arranging for witness attendance and taking statements. Continue efforts to settle claims before trial.
• Participate in claim file reviews and audits with customers/insureds and brokers.
• Administer benefits timely and appropriately. Maintain control of the claims resolution process to minimize current exposure and future risks.

Education & Experience:

• 1-3 years experience in handling workers compensation claims in Defense Based Act/Longshore is preferred with prior experience at ESIS or similar third-party administrators being advantageous and/or Bachelors degree or equivalent experience.
• Industry Knowledge: Strong familiarity with workers compensation laws medical terminology and best practices in claims handling is preferred.
• Technical Skills: Demonstrated proficiency in claims management systems and the Microsoft Office Suite.
• Communication Skills: Excellent written and verbal communication skills enabling effective interactions with external investigative sources and insureds over the phone.
• Team Collaboration: Proven ability to contribute effectively within a team environment providing and receiving constructive feedback while identifying growth opportunities for both self and colleagues.
• Analytical Skills: Strong analytical and problem-solving abilities to navigate complex scenarios efficiently.
• Organizational Skills: Capable of managing multiple priorities and meeting deadlines in a fast-paced work environment.
• Customer Focus: Strong commitment to customer service with a proactive approach to addressing and supporting customer needs.
• Judgment and Decision-Making: Confidence in personal judgment with the ability to support and defend decisions made.
• Commitment to Excellence: Dedicated to maintaining high standards of behavior and performance.
• Adaptability: Flexible in adapting approaches and behaviors to fit specific situations effectively.
• Positive Representation: Strong focus on building and maintaining a positive image for Chubb and ESIS.