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!

The ESIS Senior Workers' Compensation Claim Representative, under the direction of the Claims Team Leader, is responsible for investigating and resolving claims promptly, fairly, and in accordance with established best practices.

Major Duties & Responsibilities, but are not limited to:


* 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, legal representatives, 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 detailing 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 remedial actions.


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


* 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, insured parties, customers, or legal representatives as appropriate.

QUALIFICATIONS



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


* Demonstrated ability to communicate clearly and professionally, with strong interpersonal skills for effective interactions with claimants, customers, insured parties, 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.


* Strong negotiation skills.


* Experience handling workers' compensation claims in Oregon or Hawaii is pr...