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.

KEY OBJECTIVE:
Under the guidance of the Claims Team Leader, the Claims Specialist investigates and resolves claims efficiently, fairly, and in accordance with established best practices.

MAJOR DUTIES & RESPONSIBILITIES:
Primary responsibilities include, but are not limited to:


* Receive and review new claim assignments.


* Analyze claim and policy information to determine coverage and the extent of the company's obligations.


* Conduct interviews and obtain statements (recorded or in person) from insured parties, claimants, witnesses, medical professionals, legal representatives, and law enforcement as needed.


* Arrange for surveys and consult with subject matter experts when appropriate.


* Evaluate investigative findings to determine liability and coverage under the policy.


* Prepare comprehensive reports on investigations, settlements, claim denials, and evaluations.


* Set and recommend changes to reserves within established authority limits.


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


* Manage litigation files in a timely and appropriate manner.


* Support the Team Leader in identifying and implementing process improvements.


* Resolve claims promptly and equitably.


* Obtain necessary documentation such as releases, proofs of loss, or compensation agreements, and issue payments for claims and related expenses.


* Communicate claim decisions to claimants, insured parties, agents, or attorneys as appropriate.


* Assist in preparing cases for trial, including arranging witness attendance and gathering statements, while continuing efforts to resolve claims prior to trial.


* Refer claims for subrogation when applicable.


* 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 current and future exposure.


* Build and maintain strong working relationships with customers, agents, underwriters, and experts.

Additional responsibilities, depending on line of business, may include:


* Maintaining system logs.


* Investigating compensability and benefit entitlement.


* Reviewing and approving medical bill payments or coordinating external reviews as ne...