Combined Insurance ESIS WC Claims Representative in United States

The Claim Representative, under direct supervision initially, performs customer service and/or claims functions within a specific business line while training to become a claims representative. Gains exposure to all facets of a professional claims representative position through classroom and hands on learning.

SCOPE INFORMATION:

This position reports to a Technical Claims Team Leader. There are no positions reporting into this position.

MAJOR DUTIES & RESPONSIBILITIES:

Duties may include, but are not limited to:

Investigates new losses and making compensability determinations

Deals with insureds, injured workers, medical providers and attorneys during the course of handling each claim.

Handles jurisdictional notices, payment of benefits, obtaining medical updates to move claims to resolution.

Negotiates settlements and manages litigation.

Sets reserves within authority limits and recommends reserve changes to Team Leader.

Refers claims to subrogation as appropriate. .

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

DESIRED QUALIFICATIONS:

College graduate. No experience required.

Strong customer orientation to respond to and support customer needs.

Strong written and oral communication skills to effectively deal with outside investigative sources and with insureds by telephone.

Strong analytical and organizational ability

Strong PC experience to be comfortable in an automated environment.

Works well within a team environment to give and solicit feedback, identify opportunities for growth of self and other team members.

Believes in own judgment and acts to support or defend own choices.

Committed to high standards of behavior and performance.

Adapts own approach or behavior to particular situation.

Builds and maintains positive image for the company.

Job: *Claims

Title: ESIS WC Claims Representative

Location: null

Requisition ID: 322972