ESIS Claims Representative, WC

JOB DESCRIPTION

Major Duties & Responsibilities


* Under close supervision, receive assignments and review 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.


* Contact, interview, and obtain statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc., to secure necessary claim information.


* Evaluate facts supplied by the investigation to determine the extent of liability of the insured, if any, and the extent of 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.


* Prepare and submit to the Team Leader any unusual or potentially undesirable exposures.


* 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 payments on claims.


* Inform claimants, insureds/customers, or attorneys of claim denials when applicable.


* Assist the Team Leader and company attorneys in preparing cases for trial by arranging for witness attendance and taking statements.

Continue efforts to settle claims before trial.


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


* Administer benefits timely and appropriately.

Maintain control of the claims resolution process to minimize current exposure and future risks.

QUALIFICATIONS



* Preferred Qualifications: 1-3 years' experience in handling workers' compensation claims in Florida/Georgia/Alabama is preferred, with prior experience at ESIS or similar third-party administrators being advantageous, and/or Bachelor's degree or equivalent experience.


* Industry Knowledge: Strong familiarity with workers' compensation laws, medical terminology, and best practices in claims handling is preferred.


* Technical Skills: Demonstrated proficiency in claims management systems and the Microsoft Office Suite.


* Communication Skills: Excellent written and verbal communication skills, enabling effective interactions with external investigative sources and insureds over the phone.


* Team Collaboration: Proven ability to contribute effectively within a team environment, providing and receiving constructive feedback while identifying growth opportunities for both self and colleagues.


* Analytical Skills: Strong analytical and problem-solving abilities to navigate complex scenarios efficiently.


* Organizational Skills: Capable of managing multipl...