ESIS Senior Claims Representative, AGL

JOB DESCRIPTION

Responsibilities include, but are not limited to:


* Receives assignments and reviews claim and policy information to provide background for investigations.

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 individuals, claimants, witnesses, medical professionals, legal representatives, law enforcement, and other relevant parties to gather necessary claim information.


* Depending on the line of business, may inspect and appraise damage for property losses or arrange for such appraisal.


* Evaluates facts obtained during investigations to determine the extent of liability and the company's obligation under the policy contract.


* Prepares reports on investigations, settlements, claim denials, and evaluations of involved parties.


* Sets reserves within authority limits and recommends reserve changes to the Team Leader.


* Reviews the progress and status of claims with the Team Leader, discussing challenges and recommending solutions.


* Prepares and submits to the Team Leader any unusual or potentially undesirable exposures.


* Assists the Team Leader in developing methods and improvements for handling claims.


* Resolves claims promptly and fairly.


* Obtains releases, proofs of loss, or compensation agreements and issues company drafts for claim payments.


* Communicates claim denials to claimants, insureds/customers, or attorneys as applicable.


* Manages litigation as required.

QUALIFICATIONS



* Minimum of 5 years of technical claims handling experience in Auto and General Liability lines, demonstrating a high level of knowledge and competence.


* Experience working in a Third-Party Administrator (TPA) environment is strongly preferred.


* Must obtain and maintain required state licenses.


* Strong knowledge of insurance coverages and a solid understanding of applicable legal principles.


* Familiarity with auto liability cost containment programs and proven account management skills.


* Excellent communication, negotiation, and interpersonal skills for effective interaction with all levels of internal and external stakeholders.


* Strong analytical and problem-solving abilities.


* Demonstrated commitment to providing consistently superior customer service.

An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters.

Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims.

ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.

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