ESIS Senior Claims Representative, WC

Are you looking to grow your career in workers’ compensation and claims support? Join ESIS, a leader in risk management and insurance services, where you can help support effective claims handling and contribute to positive outcomes for employees and clients.

Under the direction of the Claims Team Leader, the Senior Workers’ Compensation Claim Representative investigates and resolves claims promptly, fairly, and in accordance with established best practices.

Duties may include, but are not limited to:

• Receive and manage new claim assignments.
• Review claim and policy information to establish the background for investigation and determine the extent of the policy’s 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, and others to gather necessary claim information.
• Arrange for surveys and expert evaluations, as appropriate.
• Evaluate facts obtained through investigation to determine liability, if any, and the company’s obligation to the insured under the policy contract.
• Prepare reports related to investigations, settlements, claim denials, and evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader.
• Review claim progress and status with the Team Leader and discuss issues and recommended corrective actions.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and process improvements for claims handling.
• Resolve claims promptly and fairly.
• Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
• Inform claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
• May assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and taking statements. Continue efforts to resolve claims before trial.
• Refer claims to subrogation, as appropriate.
• May participate in claim file reviews and audits with customers, insureds, and brokers.
• Administer benefits in a timely and appropriate manner. Maintain control of the claim resolution process to minimize current exposure and future risk.
• Establish and maintain strong working relationships with agents, underwriters, insureds, experts, and other stakeholders.

Depending on line of business, other duties may include:

• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments or forwarding them for outside review, as necessary
• Managing vocational rehabilitation