Description

JOB DESCRIPTION

Join ESIS, a leader in risk management and insurance services, and contribute to work that supports safer workplaces and effective claims outcomes. We are seeking a skilled and collaborative professional to help manage workers' compensation claims with accuracy, responsiveness, and a strong focus on service.

At ESIS, we value integrity, accountability, and continuous improvement. This role offers the opportunity to work in a team-oriented environment where you can apply your expertise, grow your career, and make a meaningful contribution to our clients and their employees.

KEY OBJECTIVE:
Under the guidance of the Claims Team Leader, the Claims Specialist investigates and resolves claims efficiently, fairly, and in accordance with established best practices.

MAJOR DUTIES & RESPONSIBILITIES:
Primary responsibilities include, but are not limited to:

• Receive and review new claim assignments.
• Analyze claim and policy information to determine coverage and the extent of the company's obligations.
• Conduct interviews and obtain statements (recorded or in person) from insured parties, claimants, witnesses, medical professionals, legal representatives, and law enforcement as needed.
• Arrange for surveys and consult with subject matter experts when appropriate.
• Evaluate investigative findings to determine liability and coverage under the policy.
• Prepare comprehensive reports on investigations, settlements, claim denials, and evaluations.
• Set and recommend changes to reserves within established authority limits.
• Review claim progress and status with the Team Leader, discussing challenges and recommending solutions.
• Manage litigation files in a timely and appropriate manner.
• Support the Team Leader in identifying and implementing process improvements.
• Resolve claims promptly and equitably.
• Obtain necessary documentation such as releases, proofs of loss, or compensation agreements, and issue payments for claims and related expenses.
• Communicate claim decisions to claimants, insured parties, agents, or attorneys as appropriate.
• Assist in preparing cases for trial, including arranging witness attendance and gathering statements, while continuing efforts to resolve claims prior to trial.
• Refer claims for subrogation when applicable.
• Participate in claim file reviews and audits with customers, insured parties, and brokers.
• Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize current and future exposure.
• Build and maintain strong working relationships with customers, agents, underwriters, and experts.

Additional responsibilities, depending on line of business, may include:

• Maintaining system logs.
• Investigating compensability and benefit entitlement.
• Reviewing and approving medical bill payments or coordinating external reviews as needed.
• Managing vocational rehabilitation processes.

SCOPE INFORMATION:

• This position reports directly to the Claims Team Leader or another member of the claims management team.

Requisition #: 33294

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