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ESIS Claims Representative - Workers Compensation

Job Description

The Claim Representative, 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 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 insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
  • Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.
  • 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.
  • Prepares and submits to Team Leader unusual or possible undesirable exposures. 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.
  • Informs claimants, insureds/customers 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 arrange for salvage disposition or other recovery proceedings as necessary by line of business.
  • 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

Depending on line of business, other duties may include:

  • Maintaining system logs
  • Investigating compensability and benefit entitlement
  • Reviewing and approving medical bill payments
  • Managing vocational rehabilitation

DESIRED QUALIFICATIONS:

  • 2-5 years’ experience handling claims in a relevant line of business.
  • Basic knowledge of claims handling and familiarity with claims terminologies
  • Effective negotiation skills
  • Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc. in a positive manner concerning losses.
  • Ability to self-motivate and work independently
  • Knowledge of company products, services, coverage’s and policy limits, along with awareness of the company’s claims best practices
  • Knowledge of applicable state and local laws

Job Snapshot

Employment Type Full-Time
Job Type Management
Education Not Specified
Experience Not Specified
Manages Others Not Specified
Industry Real Estate - Property Mgt
Required Travel None
Job ID 312535
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ESIS Claims Representative - Workers Compensation


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