ESIS Claims Representative, WC

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!

The ESIS Claims Representative for Workers' Compensation position is based in our Tampa, Florida office.

The Workers’ Compensation Claims Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.

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.

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 and timely issues indemnity benefits if due and owing.

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 taking statements. Continues efforts to settle claims before trial.

Refers claims to subrogation as appropriate.

May participate in claim file reviews and audits with customer/insured and broker. Administers Workers’ Compensation benefits timely and appropriately per Jurisdiction. Maintains control of claim’s resolution process to minimize current exposure and future risks

Establishes and maintains strong customer relations

Other duties may include:

Working all queues and diary in a timely manner

Investigating compensability and benefit entitlement

Reviewing and approving medical bill payments

Managing vocational rehabilitation

Qualifications

2-5 years’ experience handling Workers’ Compensation claims

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, excels in organization and time management skills

Knowledge of company products, services, coverages, and policy limits, along with awareness of the company’s claims best practices and client service instructions

Knowledge of applicable state and local laws.