ESIS Senior Claims Representative, WC

JOB DESCRIPTION

ESIS Senior Claims Representative, WC

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

Education and Experience

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 workers' compensation claims, demonstrated through claims handling experience at ESIS or a similar organization, preferably 5+ years.


* Strong knowledge of workers' compensation products, services, coverages, and applicable legal principles.


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


* Insurance designations such as AIC, ARM, AICPCU, or similar credentials are preferred.


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