ESIS Senior Claims Representative, WC

JOB DESCRIPTION

ESIS Senior Claims Representative, Cheektowaga, NY

The ESIS Senior Claims Representative, WC is responsible for managing workers' compensation claims with a high level of technical expertise, sound judgment, and strong customer service.

This role partners with internal and external stakeholders to investigate claims, evaluate liability and exposure, and drive timely, equitable resolutions that support positive outcomes for all parties involved.

Key Responsibilities

Depending on line of business, responsibilities may include:


* Receive and manage new claim assignments.


* Review claim and policy information to support investigation and determine the extent of the company's obligation under the policy, as applicable.


* Contact and interview insureds, claimants, witnesses, physicians, attorneys, police officers, and other relevant parties to gather necessary claim information.


* Arrange surveys and engage experts when appropriate.


* Evaluate facts gathered through investigation to determine liability and the company's obligation 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 challenges and recommended next steps.


* Manage litigation files in a timely and appropriate manner.


* Support the Team Leader in identifying process improvements and enhanced claim handling methods.


* Resolve claims promptly and equitably.


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


* Communicate claim denials to claimants, insureds, customers, agents, or attorneys, as appropriate.


* Support the Team Leader and company attorneys in trial preparation by coordinating witness attendance and obtaining statements, while continuing settlement efforts when possible.


* Refer claims to subrogation as appropriate.


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


* Administer benefits in a timely and appropriate manner while maintaining 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 partners.


* Maintain accurate system logs and documentation.

QUALIFICATIONS

Experience and Education

The ideal candidate is a collaborative, analytical, and customer-focused claims professional with strong technical knowledge of workers' compensation claims and the ability to manage complex files independently.



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


* High level of technical claims knowledge and competence in w...