ESIS Claims Representative, WC

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

Key Objective:

Under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.

Duties May Include But Are Not Limited To:

• Receive new assignments.
• Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business.
• Contacts, interviews and obtains statements (recorded or in person) from insured's, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
• Arrange for surveys and experts where appropriate.
• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's 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.
• Timely and appropriate management of litigation files.
• 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 and expenses.
• Informs claimants, insured's/customers/ agents 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 participate in claim file reviews and audits with customer/insured and broker.
• Administers benefits timely and appropriately. Maintains control of claim's resolution process to minimize current exposure and future risks
• Establishes and maintains strong customer relations i.e. agents, underwriters, insureds, experts

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 for outside review as necessary.
• Managing vocational rehabilitation

Scope:

The position reports directly to a Claims Team Leader or other member of claims management.