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.