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 are dedicated to providing exceptional service and innovative solutions, and we are looking for passionate individuals to be part of our dynamic team.

If you are 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!

We are seeking a skilled Senior Claims Representative to enhance our team.

Reporting to the Claims Team Leader, this role plays a vital part in investigating and managing claims promptly and equitably, in line with established best practices.

This is a hybrid position, with three days per week in-office.

Duties include but are not limited to:


* With limited supervision, receives assignments and reviews claim and policy information to provide background for investigation.

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, legal representatives, law enforcement, and others as needed to secure necessary claim information.


* Evaluates facts obtained during the investigation 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 authority limits and recommends reserve changes to the Team Leader as appropriate.


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


* 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 equitably.


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


* Informs claimants, insured parties, customers, or legal representatives of claim denials when applicable.

QUALIFICATIONS



* Minimum of 4 years' experience handling workers' compensation claims.


* Strong communication and interpersonal skills to interact positively and effectively with claimants, customers, insured parties, brokers, attorneys, and others regarding losses.


* Ability to work independently and demonstrate self-motivation.


* Knowledge of company products, services, coverages, and policy limits, as well as familiarity with the company's claims best practices.


* Effective negotiation skills.


* Prefere...