ESIS Senior Claims Representative, 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.

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.

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.