ESIS Claims Specialist, WC

Are you looking to grow your career in workers’ compensation and claims support? Join ESIS, a leader in risk management and insurance services, where you can help support effective claims handling and contribute to positive outcomes for employees and clients.

Under the direction of the Claims Team Leader, the ESIS Claims Specialist investigates, evaluates, and settles claims promptly, fairly, and in accordance with established best practices and company guidelines.

Duties include, but are not limited to:

• Under limited supervision, receives assignments and reviews claim and policy information to support the investigation and 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, and others to gather necessary claim information.
• Evaluates facts obtained through investigation to determine the extent of the insured’s liability, if any, and the company’s obligation under the policy contract.
• Prepares reports related to investigations, settlements, claim denials, and evaluations of involved parties.
• Establishes reserves within authority limits and recommends reserve changes to the Team Leader.
• Reviews claim progress and status with the Team Leader and discusses issues and recommended corrective actions.
• Submits unusual or potentially adverse exposures to the Team Leader for review.
• Assists the Team Leader in developing process improvements and enhanced methods for handling claims.
• Settles claims promptly and equitably.
• Obtains releases, proofs of loss, or compensation agreements and issues company drafts for claim payments.
• Notifies claimants, insureds/customers, or attorneys of claim denials when applicable.