ESIS Senior Claims Representative, WC

JOB DESCRIPTION

ESIS Senior Claims Representative, WC

Key Objective
Under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably, and in accordance with established best-practice guidelines.

Major Duties and Responsibilities
Duties may include, but are not limited to:


* Receive new assignments.


* Review claim and policy information to establish background for investigation and determine the extent of the policy's obligation 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 secure necessary claim information.


* Arrange for surveys and experts where appropriate.


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


* Prepare reports on investigations, settlements, claim denials, and individual 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 and discuss issues and recommended corrective actions.


* Manage litigation files in a timely and appropriate manner.


* Assist the Team Leader in developing methods and 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.


* May assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and taking statements.

Continue efforts to settle claims before trial.


* Refer claims to subrogation as appropriate.


* May participate in claim file reviews and audits with customers, insureds, and brokers.


* Administer benefits in a timely and appropriate manner.

Maintain control of the claim resolution process to minimize current exposure and future risk.


* Build and maintain strong customer relationships with agents, underwriters, insureds, and experts.

QUALIFICATIONS

Experience & Education


* Four-year college degree and/or equivalent work experience; additional degrees such as an MBA are a plus.


* Strong technical claims knowledge and demonstrated competence in Workers' Compensation claims, supported by claims handling experience at ESIS (preferably 5 years) or within a similar organization.


* Thorough knowledge of Workers' Compensation products, services, and coverages, along with a solid understanding of applicable legal principles.


* Knowledge of WC cost containment programs and proven account management skills.


* Demonstrated effective communication and interpersonal skills, with ...