ESIS Senior 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!

Reporting to the Claims Team Leader, the ESIS Senior Claim Representative is responsible for investigating and resolving workers' compensation claims promptly, equitably, and in accordance with established best practices.

This role handles complex and intricate claims, requiring advanced expertise and judgment.

Duties include, but are not limited to:


* With limited supervision, receives assignments and reviews claim and policy information to provide background for investigations, and may determine the extent of the policy's obligation to the insured, depending on the line of business.


* Contacts, interviews, and obtains statements from insured parties, claimants, witnesses, medical professionals, attorneys, law enforcement, and other relevant individuals to gather necessary claim information.


* 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 individual evaluations of involved parties.


* Sets reserves within designated authority limits and recommends reserve adjustments to the Team Leader as needed.


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


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


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


* Settles claims promptly and fairly.


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


* Notifies claimants, insureds, customers, or attorneys of claim denials when applicable.

QUALIFICATIONS



* Minimum of four years' experience handling workers' compensation claims.


* Strong communication and interpersonal skills for positive and effective interactions with claimants, customers, insureds, brokers, attorneys, and other stakeholders.


* Proven ability to work independently and demonstrate self-motivation.


* Solid understanding of company products, services, coverages, policy limits, and claims best practices.


* Effective negotiation skills.


* Experience handling workers'...