ESIS Senior Claims Representative, WC

JOB DESCRIPTION

Join ESIS, a leader in risk management and insurance services, and contribute to work that supports safer workplaces and effective claims outcomes.

We are seeking a skilled and collaborative professional to help manage workers' compensation claims with accuracy, responsiveness, and a strong focus on service.

At ESIS, we value integrity, accountability, and continuous improvement.

This role offers the opportunity to work in a team-oriented environment where you can apply your expertise, grow your career, and make a meaningful contribution to our clients and their employees.

Duties may include, but are not limited to:


* Receive and manage new claim assignments.


* Review claim and policy information to establish the background for investigation and determine the extent of the policy's obligations to the insured, depending on the line of business.


* Contact, interview, and obtain statements, recorded or in person, from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather necessary claim information.


* Arrange surveys and engage experts when appropriate.


* Evaluate facts obtained through investigation to determine the extent of liability, if any, and the company's obligations under the policy contract.


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


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


* Review claim progress and status with the Team Leader and discuss issues and recommended actions.


* Manage litigation files in a timely and appropriate manner.


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


* Settle claims promptly and equitably.


* Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.


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


* Assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and obtaining statements, while continuing settlement efforts prior to trial.


* Refer claims to subrogation as appropriate.


* Participate in claim file reviews and audits with customers, insureds, and brokers as needed.


* Administer benefits in a timely and appropriate manner and maintain control of the claim resolution process to help minimize current exposure and future risk.


* Build and maintain strong working relationships with agents, underwriters, insureds, experts, and other stakeholders.

Depending on the line of business, additional duties may include:


* Maintaining system logs


* Investigating compensability and benefit entitlement


* Reviewing and approving medical bill payments or forwarding them for outside review as needed


* Managing vocational rehabilitation

Scope...