Description

JOB DESCRIPTION

Join ESIS, a leader in risk management and insurance services, and contribute to work that supports safer workplaces and effective claims outcomes. We are seeking a skilled and collaborative professional to help manage workers' compensation claims with accuracy, responsiveness, and a strong focus on service.

At ESIS, we value integrity, accountability, and continuous improvement. This role offers the opportunity to work in a team-oriented environment where you can apply your expertise, grow your career, and make a meaningful contribution to our clients and their employees.

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 obligations 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 surveys and engage experts when appropriate.
• Evaluate facts obtained through investigation to determine the extent of liability, if any, and the company's obligations under the policy contract.
• Prepare reports related to investigations, settlements, claim denials, and evaluations of involved parties.
• Establish 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 actions.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and process improvements for claims handling.
• Settle claims promptly and equitably.
• 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.
• Assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and obtaining statements, while continuing settlement efforts prior to trial.
• Refer claims to subrogation as appropriate.
• Participate in claim file reviews and audits with customers, insureds, and brokers as needed.
• Administer benefits in a timely and appropriate manner and maintain control of the claim resolution process to help minimize current exposure and future risk.
• Build and maintain strong working relationships with agents, underwriters, insureds, experts, and other stakeholders.

Depending on the line of business, additional duties may include:

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

Scope Information:

This position reports directly to a Claims Team Leader or another member of claims management.

Requisition #: 33697

tcv57hlu2