Description

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, we are dedicated to providing exceptional service and innovative solutions, and we are looking for passionate individuals to be part of our dynamic team. If you are 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!

We are seeking a Claims Representative to enhance our team.

This is a hybrid position, with three days per week in-office.

Under the direction of the Claims Team Leader, the ESIS Claim Representative investigates and resolves claims promptly, equitably, and in accordance with established best practice guidelines.

Major Duties & Responsibilities:

• Receive and manage claim assignments.
• Review claim and policy information to provide context for investigations and determine the extent of policy obligations, depending on the line of business.
• Contact, interview, and obtain statements from insured parties, claimants, witnesses, medical professionals, attorneys, police officers, and others to secure necessary claim information.
• Inspect and appraise property damage or arrange for appraisal, as required by the line of business.
• Evaluate investigation findings to determine liability and the company's obligations under policy contracts.
• Prepare reports on 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, discussing challenges and recommending solutions.
• Submit unusual or potentially undesirable exposures to the Team Leader and assist in developing improved claim handling methods.
• Resolve claims promptly and equitably.
• Obtain releases, proofs of loss, or compensation agreements and issue payments for claims.
• Inform claimants, insured parties, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial, including arranging witness attendance and taking statements, while continuing efforts to settle claims before trial.
• Refer claims to subrogation as appropriate and arrange for salvage disposition or other recovery proceedings as needed.
• Participate in claim file reviews and audits with customers, insured parties, and brokers.
• Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize exposure and future risks.
• Establish and maintain strong customer relationships.

Additional duties may include, depending on the line of business:

• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments
• Managing vocational rehabilitation

Requisition #: 33230

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