ESIS Claims Associate, WC

Chubb•Tigard, OR

18h•$67,000 - $83,000•Hybrid

About The Position

Under the direction of the Claims Team Leader, the ESIS Claim Representative investigates and resolves claims promptly, equitably, and in accordance with established best practice guidelines. ESIS is a leader in risk management and insurance services, dedicated to providing exceptional service and innovative solutions. This is a hybrid position, with three days per week in-office.

Requirements

Workers' compensation claims experience
Ability to investigate and resolve claims promptly and equitably
Knowledge of best practice guidelines for claims handling
Ability to review claim and policy information
Ability to contact, interview, and obtain statements from various parties
Ability to evaluate investigation findings to determine liability and obligations
Ability to prepare reports on investigations, settlements, denials, and evaluations
Ability to set reserves and recommend reserve changes
Ability to review claim progress and status with a Team Leader
Ability to submit unusual exposures and assist in developing improved claim handling methods
Ability to obtain releases, proofs of loss, or compensation agreements
Ability to issue payments for claims
Ability to inform claimants, insured parties, or attorneys of claim denials
Ability to assist in preparing cases for trial
Ability to refer claims to subrogation and arrange for recovery proceedings
Ability to participate in claim file reviews and audits
Ability to administer benefits in a timely and appropriate manner
Ability to maintain control of the claim resolution process
Ability to establish and maintain strong customer relationships

Responsibilities

Receive and manage claim assignments.
Review claim and policy information to provide context for investigations and determine the extent of policy obligations, depending on the line of business.
Contact, interview, and obtain statements from insured parties, claimants, witnesses, medical professionals, attorneys, police officers, and others to secure necessary claim information.
Inspect and appraise property damage or arrange for appraisal, as required by the line of business.
Evaluate investigation findings to determine liability and the company’s obligations under policy contracts.
Prepare reports on investigations, settlements, claim denials, and evaluations of involved parties.
Set reserves within authority limits and recommend reserve changes to the Team Leader.
Review claim progress and status with the Team Leader, discussing challenges and recommending solutions.
Submit unusual or potentially undesirable exposures to the Team Leader and assist in developing improved claim handling methods.
Resolve claims promptly and equitably.
Obtain releases, proofs of loss, or compensation agreements and issue payments for claims.
Inform claimants, insured parties, or attorneys of claim denials when applicable.
Assist the Team Leader and company attorneys in preparing cases for trial, including arranging witness attendance and taking statements, while continuing efforts to settle claims before trial.
Refer claims to subrogation as appropriate and arrange for salvage disposition or other recovery proceedings as needed.
Participate in claim file reviews and audits with customers, insured parties, and brokers.
Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize exposure and future risks.
Establish and maintain strong customer relationships.
Maintaining system logs
Investigating compensability and benefit entitlement
Reviewing and approving medical bill payments
Managing vocational rehabilitation