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 within established best practices guidelines.

MAJOR DUTIES & RESPONSIBILITIES:

Duties may include but are not limited to:

• Receive new assignments.

• Reviews claim and policy information to provide background for investigation and may determine the extent of the policy's obligation to the insured depending on the line of business.

• Contacts, interviews and obtains statements (recorded or in person) from insured's, claimants, witnesses, physicians, attorneys, police officers, etc.

to secure necessary claim information.

• Arrange for surveys and experts where appropriate.

• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company's obligation to the insured under the policy contract.

• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.

• Sets reserves within authority limits and recommends reserve changes to Team Leader.

• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.

• Timely and appropriate management of litigation files.

• Assists Team Leader in developing methods and improvements for handling claims.

• Settles claims promptly and equitably.

• Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims and expenses.

• Informs claimants, insured's/customers/ agents or attorney of denial of claim when applicable.

• May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements.

Continues efforts to settle claims before trial.

• Refers claims to subrogation as appropriate.

• May participate in claim file reviews and audits with customer/insured and broker.

• Administers benefits timely and appropriately.

Maintains control of claim's resolution process to minimize current exposure and future risks

• Establishes and maintains strong customer relations i.e.

agents, underwriters, insureds, experts

Depending on line of business, other duties may include:

• Maintaining system logs

• Investigating compensability and benefit entitlement

• Reviewing and approving medical bill payments or forwarding for outside review as necessary.

• Managing vocational rehabilitation

SCOPE INFORMATION: The position reports directly to a Claims Team Leader or other member of claims management.

QUALIFICATIONS

• Four-year college degree and/or equivalent work experience or additional degrees (ex.

MBA)

• High level of technical claims knowledge and competence in Workers' Comp claims, as evidenced by demonstrated claims handling experience at ESIS (preferably 5 years claims handling experience), or within a similar ...