Description

JOB DESCRIPTION

Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. At ESIS, we're dedicated to providing exceptional service and innovative solutions, and we're looking for passionate individuals to be part of our dynamic team. If you're eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere!

As an ESIS Claims Specialist, your primary responsibility will be to investigate and resolve claims efficiently and fairly under the guidance of the Claims Team Leader. Your goal is to ensure that all claims are processed in accordance with established best practices, while delivering exceptional service to our clients.

Major Duties & Responsibilities:

As a Claims Specialist, your duties will encompass the following responsibilities (but are not limited to):

• Claim Assignment and Review: Promptly receive and review new assignments, analyzing claim and policy information to set the foundation for thorough investigations, while assessing the policy's obligations based on the specific line of business.
• Information Gathering: Conduct in-depth interviews and secure statements (both recorded and in-person) from insured parties, claimants, witnesses, healthcare providers, legal representatives, and law enforcement to collect essential claim information.
• Expert Coordination: Collaborate with experts and arrange for surveys when necessary to support claims investigations.
• Liability Evaluation: Assess the facts obtained during investigations to determine the insured's liability, if applicable, and the extent of the company's obligations under the policy contract.
• Reporting and Documentation: Prepare comprehensive reports that encompass investigation findings, claim settlements, denials, and evaluations of involved parties to maintain accurate and current records.
• Reserve Management: Set reserves within your authority limits and recommend changes to reserves to the Claims Team Leader as appropriate.
• Claims Progress Review: Regularly discuss the status and progress of claims with the Claims Team Leader, addressing any challenges and proposing solutions.
• Litigation Management: Oversee litigation files proactively to ensure timely and appropriate management, while striving to settle claims before progressing to trial.
• Assist with Legal Preparations: Support the Team Leader and company attorneys in trial preparations by organizing witness attendance and collecting statements, while actively seeking opportunities to settle claims prior to litigation.
• Subrogation Referrals: Identify and refer claims for subrogation as relevant to recover costs.
• File Audits and Reviews: Participate in claim file reviews and audits alongside customers, insured parties, and brokers to ensure compliance and accuracy.
• Timely Benefits Administration: Administer benefits promptly and fairly, while maintaining control of the claims resolution process to mitigate risk and exposure.
• Customer Relationship Management: Establish and uphold strong relationships with all stakeholders, including agents, underwriters, insured parties, and industry experts, to enhance customer satisfaction.

Additional Responsibilities (Depending on Line of Business):

• Maintain accurate system logs.
• Investigate compensability and benefits entitlement.
• Review and authorize medical bill payments or coordinate external assessments as necessary.
• Manage vocational rehabilitation processes as needed.

Scope of Position: This position reports directly to a Claims Team Leader or another member of the claims management team, offering opportunities for collaboration and professional growth within our dynamic environment.

Requisition #: 27471

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