ESIS ProClaim Representative (Hybrid)

JOB DESCRIPTION

ESIS ProClaim is seeking an experienced Claims Representative.

In this role you will manage complex commercial auto liability and general liability claims.

Note: This is a hybrid position requiring 3 days in the office and 2 days working from home.

Key Objective:

Under the direction of the Claims Team Leader will work you manage all aspects of third-party liability claims.

You will analyze coverage, investigates facts of third-party claims, secure evidence, assesses, addresses subrogation/recovery/tenders, and apportions liability and settles claims at the best outcome within established claim best practices guidelines and client instructions.

Responsibilities:


* Review policy information to determine coverage, conducts a thorough investigation and may determine the extent of the policy's obligation to the insured depending on the line of business.


* Maintain diary system to ensure each file is reviewed at a minimum of every 90 days.


* Manage litigation.


* Develops, works and shares performance and productivity goals.


* Reviews, analyzes and shares performance results, productivity and audit/quality review results.


* Provides direction to claims professionals to be able to effectively work with defense counsel and litigation working collaboratively, as directed by the client.


* Works with assigned claims professionals to insure detailed 90-day Claim Summary Reports are prepared and provide updates to the client on investigation, potential settlement opportunities, claim denials, reservation of rights, third party tenders and recommendations to present at claims review meetings.


* Posts loss and expense reserves in Claims system within authority limits and recommends reserve changes above authority to AVP and/or VP of Claims.


* Reviews progress and status of claims with claims leadership and discusses issues/opportunities/task and remedial actions.


* Prepares and submits to claims leadership all unusual or potentially undesirable exposures such as allegations of bad faith or unfair claim practice allegations.


* Assists Claims Leadership in formulating improvements in claims handling procedures.


* Assist and works with Partnership Leaders on delivering results, attend meetings and claim reviews.


* Reviews and confirms claims professionals have secured the appropriate releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.


* Maintains claims with the appropriate file notes, reports, photos, and documentation within the claim.


* Follows all company and regulatory compliance requirements.


* Updates claim timely with Medicare data and addresses Medicare reporting & interest.


* Meets or exceeds performance goals.

QUALIFICATIONS



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