Combined Insurance ESIS - Claims Representative - Workers Compensation in United States
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 include but are not limited to:
- Under limited supervision, receives assignments and 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.
5 or more years’ experience handling claims as evidenced by career progression within the company or similar organization.
- Ability to work independently with limited direction from a Team Leader.
- Authoritative technical knowledge of claims handling and claims terminologies.
- Superior 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.
- Strong knowledge of the company’s products, services, coverage’s and policy limits, along with a solid understanding of claims best practices.
- Commanding knowledge of applicable state and local laws related to line of business handled.
- Superior customer service skills
Title: ESIS - Claims Representative - Workers Compensation
Requisition ID: 322381