ESIS ProClaim Senior Representative, A&H
About The Position
The Accident and Health Adjuster manages a daily inventory of hospital indemnity, hospital accident, and accidental death and dismemberment claims. The role reviews medical documentation, investigates losses, interprets policy language to determine coverage and payment, establishes and evaluates reserves, prepares coverage letters and reports, and provides high-quality customer service. The position reports to the Team Leader. The selected candidate should demonstrate initiative, strong organizational skills, the ability to prioritize multiple tasks, adaptability, and the ability to work effectively in a fast-paced, changing environment while meeting industry best practices and claim-handling requirements. The role requires working in the office at least three days per week.
Requirements
- Strong project management skills and the ability to work independently.
- Proficiency with Microsoft Office applications, including Excel, Word, and PowerPoint.
- Strong written communication skills, including the ability to document policy interpretations clearly.
- Strong customer service skills.
- Ability to work collaboratively, adapt to changing priorities, and contribute positively to a team environment.
- For ESIS Field Claims Adjusters, an applicable resident or designated home state adjuster’s license is required. ESIS allows up to four months to pass the adjuster licensing exam.
Nice To Haves
- Experience using claims-handling systems.
- Adjuster licensing preferred.
- Claims-handling experience preferred.
Responsibilities
- Receive assignments and review claim and policy information to investigate claims and determine the extent of the policy’s obligation to the insured.
- Contact, interview, and obtain recorded or in-person statements from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather claim information.
- For applicable lines of business, inspect and appraise property damage or arrange for an appraisal.
- Evaluate investigation findings to determine liability and the company’s obligation under the policy contract.
- Prepare reports concerning investigations, settlements, claim denials, and evaluations of involved parties.
- Establish reserves within authority limits and recommend reserve changes to the Team Leader.
- Review claim progress and status with the Team Leader and discuss issues and recommended corrective actions.
- Submit unusual or potentially adverse exposures to the Team Leader for review.
- Assist the Team Leader in developing claims-handling methods and process improvements.
- Settle claims promptly and fairly.
- Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim payments.
- Inform claimants, insureds or customers, and attorneys of claim denials when applicable.
Benefits
- Comprehensive benefits package.
- May be eligible to participate in a discretionary annual incentive program.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
