ESIS Claims Representative, WC

JOB DESCRIPTION

ESIS Claims Representative, WC

Locations: Cheektowaga, VA | Philadelphia, PA

Work Arrangement
This role follows a hybrid schedule of 3 days in office and 1 day remote.

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.


* Review claim and policy information to provide 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 supplied by 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, denials of claims, and individual evaluations of involved parties.


* Set reserves within authority limits and recommend reserve changes to the Team Leader.


* Review progress and status of claims with the Team Leader and discuss problems and suggested remedial actions.


* Manage litigation files in a timely and appropriate manner.


* Assist the Team Leader in developing methods and improvements for handling claims.


* 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.


* 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.


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


* Administer benefits timely and appropriately, maintaining control of the claim resolution process to minimize current exposure and future risks.


* Establish and maintain strong customer relations with agents, underwriters, insureds, and 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

What You'll Need


* 1-2 years of experience handling higher-level Workers' Compensation claims.


* Basic knowledge of claims handling and fami...