ESIS Senior Claims Representative, WC
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What you'll do
- Conduct thorough investigations by reviewing claims and policy information to determine the extent of the policy’s obligation to the insured.
- Contact and interview insured individuals, claimants, witnesses, healthcare providers, attorneys, law enforcement, and other relevant parties to gather necessary claim information.
- Prepare detailed reports on investigations, settlements, claim denials, and evaluations of involved parties.
- Set reserves within authority limits and recommend reserve adjustments to the Team Leader.
- Regularly review claim progress with the Team Leader, identifying challenges and recommending solutions.
- Present unusual or potentially complex exposures to the Team Leader for review.
- Collaborate on improving claims handling methods and supporting a timely and equitable settlement process.
- Obtain necessary documentation, including releases, proofs of loss, or compensation agreements, and process claim payments efficiently.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
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.
We are seeking a skilled Senior Claims Representative to join our team. Reporting to the Claims Team Leader, this role is responsible for investigating and managing claims in a timely, accurate, and equitable manner, in accordance with established best practices.
This is a hybrid position, with three days per week in the office.
Key Responsibilities:
- Conduct thorough investigations by reviewing claims and policy information to determine the extent of the policy’s obligation to the insured.
- Contact and interview insured individuals, claimants, witnesses, healthcare providers, attorneys, law enforcement, and other relevant parties to gather necessary claim information.
- Prepare detailed reports on investigations, settlements, claim denials, and evaluations of involved parties.
- Set reserves within authority limits and recommend reserve adjustments to the Team Leader.
- Regularly review claim progress with the Team Leader, identifying challenges and recommending solutions.
- Present unusual or potentially complex exposures to the Team Leader for review.
- Collaborate on improving claims handling methods and supporting a timely and equitable settlement process.
- Obtain necessary documentation, including releases, proofs of loss, or compensation agreements, and process claim payments efficiently.
Company
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