ESIS Work Comp Claims Representative
The Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.
MAJOR DUTIES & RESPONSIBILITIES:
Duties may include but are not limited to:
- Receive assignments.
- Reviews claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured depending on the line of business.
- Contacts, interviews and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
- Depending on line of business may inspect and appraise damage for property losses or arranges for such appraisal.
- Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract.
- Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
- Sets reserves within authority limits and recommends reserve changes to Team Leader.
- Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions.
- Prepares and submits to Team Leader unusual or possible undesirable exposures. Assists Team Leader in developing methods and improvements for handling claims.
- Settles claims promptly and equitably.
- Obtains releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.
- Informs claimants, insureds/customers or attorney of denial of claim when applicable.
- May assist Team Leader and company attorneys in preparing cases for trial by arranging for attendance of witnesses and taking statements. Continues efforts to settle claims before trial.
- Refers claims to subrogation as appropriate. May arrange for salvage disposition or other recovery proceedings as necessary by line of business.
- May participate in claim file reviews and audits with customer/insured and broker. Administers benefits timely and appropriately. Maintains control of claim’s resolution process to minimize current exposure and future risks
- Establishes and maintains strong customer relations
Depending on line of business, other duties may include:
- Maintaining system logs
- Investigating compensability and benefit entitlement
- Reviewing and approving medical bill payments
- Managing vocational rehabilitation
- 2-5 years’ experience handling claims in a relevant line of business.
- Basic knowledge of claims handling and familiarity with claims terminologies
- Effective negotiation skills
- Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc. in a positive manner concerning losses.
- Ability to self-motivate and work independently
- Knowledge of company products, services, coverage’s and policy limits, along with awareness of the company’s claims best practices
- Knowledge of applicable state and local laws