ESIS Senior Claims Representative, WC

ESIS Senior Claims Representative, WC, Glen Allen, VA

Under the direction of the Claims Team Leader, the Workers’ Compensation Senior Claims Representative investigates and settles claims promptly, equitably, and in accordance with established best practices guidelines.

Duties may include, but are not limited to:

• Receive assignments.
• Review claim and policy information to provide background for the investigation and 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, and others to gather necessary claim information.
• Evaluate facts gathered through the investigation to determine the extent of the insured’s liability, if any, and the company’s obligation under the policy contract.
• Prepare reports on investigations, settlements, claim denials, and evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader.
• Review claim progress and status with the Team Leader and discuss problems and recommended corrective actions.
• Submit unusual or potentially undesirable exposures to the Team Leader and assist in developing methods and improvements for claim handling.
• Settle claims promptly and equitably.
• Obtain releases and issue indemnity benefits in a timely manner when due and owing.
• Inform claimants, insureds/customers, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial by taking statements and continuing settlement efforts before trial.
• Refer claims to subrogation as appropriate.
• Participate in claim file reviews and audits with customers, insureds, and brokers as needed.
• Administer Workers’ Compensation benefits timely and appropriately in accordance with jurisdictional requirements.
• Maintain control of the claim resolution process to minimize current exposure and future risk.
• Establish and maintain strong customer relationships.

Other duties may include:

• Working all queues and diaries in a timely manner.
• Investigating compensability and benefit entitlement.
• Reviewing and approving medical bill payments.
• Managing vocational rehabilitation.