ESIS Claims Representative, WC

JOB DESCRIPTION

ESIS Claim Representative

Under the direction of the Claims Team Leader, the ESIS Claim Representative investigates and resolves claims promptly, equitably, and in accordance with established best practice guidelines.

Major Duties & Responsibilities:


* Receive and manage claim assignments.


* Review claim and policy information to provide context for investigations and determine the extent of policy obligations, depending on the line of business.


* Contact, interview, and obtain statements from insured parties, claimants, witnesses, medical professionals, attorneys, police officers, and others to secure necessary claim information.


* Inspect and appraise property damage or arrange for appraisal, as required by the line of business.


* Evaluate investigation findings to determine liability and the company's obligations under policy contracts.


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


* Set reserves within authority limits and recommend reserve changes to the Team Leader.


* Review claim progress and status with the Team Leader, discussing challenges and recommending solutions.


* Submit unusual or potentially undesirable exposures to the Team Leader and assist in developing improved claim handling methods.


* Resolve claims promptly and equitably.


* Obtain releases, proofs of loss, or compensation agreements and issue payments for claims.


* Inform claimants, insured parties, or attorneys of claim denials when applicable.


* Assist the Team Leader and company attorneys in preparing cases for trial, including arranging witness attendance and taking statements, while continuing efforts to settle claims before trial.


* Refer claims to subrogation as appropriate and arrange for salvage disposition or other recovery proceedings as needed.


* Participate in claim file reviews and audits with customers, insured parties, and brokers.


* Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize exposure and future risks.


* Establish and maintain strong customer relationships.

Additional duties may include, depending on the line of business:


* Maintaining system logs


* Investigating compensability and benefit entitlement


* Reviewing and approving medical bill payments


* Managing vocational rehabilitation

QUALIFICATIONS



* 2-5 years of experience handling claims in a relevant line of business.


* Basic knowledge of claims handling processes and familiarity with claims terminology.


* Effective negotiation skills.


* Strong communication and interpersonal abilities to engage positively with claimants, customers, insured parties, brokers, attorneys, and others regarding losses.


* Ability to self-motivate and work independently.


* Knowledge of company products, services, coverage, and policy limit...