ESIS Senior Claims Representative, AGL

JOB DESCRIPTION

Summary:

ESIS is seeking an experienced PIP Claims representative for the Overland Park, KS office.

The person in this role will handle and maintain all PIP claims and file reviews under general supervision of a supervisor and as part of the ESIS team.

KEY OBJECTIVE:

Under the direction of the Claims Team Leader investigates and settles PIP claims promptly, equitably and within established best practices guidelines.

MAJOR DUTIES & RESPONSIBILITIES:

Duties include but are not limited to:

Under limited supervision, Receives assignments and 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 from insureds, claimants, witnesses, physicians, attorneys, police officers, etc.

to secure necessary claim information.

Manage PIP claims including arbitrations and suits within statutory guidelines, review for SIU.

Evaluates facts supplied by investigation and extent 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.

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.

QUALIFICATIONS

High level of PIP technical claims knowledge and competence as evidenced by a minimum of 5 years claims handling experience in specific line of business (PIP).

Experience within a TPA environment strongly preferred.

Required to obtains specific state licenses.

Knowledge of coverages; along with a good understanding of applicable legal principles and litigation management.

Knowledge of auto liability cost containment programs and proven account management skills a must.

Excellent communication, negotiation and interpersonal skills to effectively interact with all levels of an organization both internal and external.

Strong analytical and problem solving ability, superior organizational skills to manage claims in a fast-paced environment

New York PIP (No Fault) experience preferred including managing AAA arbitrations and suits

Demonstrated ability to provide consistent superior service to customers.

An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters.

Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims.

ESIS supports indepen...