ESIS Claims Associate (340906)
The Workers’ Compensation 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.
- 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