ESIS Senior Claims Representative, WC

Chubb External • Albuquerque, NM

84d

About The Position

Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. At ESIS, we’re dedicated to providing exceptional service and innovative solutions, and we’re looking for passionate individuals to be part of our dynamic team. If you’re eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere! The Workers’ Compensation Senior Claims Representative, Pension Desk under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.

Responsibilities

• Receive assignments.
• Review 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.
• Contact, interview, and obtain statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information.
• Evaluate facts supplied by investigation to determine extent of liability of the insured, if any, and extent of the company’s obligation to the insured under the policy contract.
• Prepare reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc.
• Set reserves within authority limits and recommend reserve changes to Team Leader.
• Review progress and status of claims with Team Leader and discuss problems and suggested remedial actions.
• Prepare and submit to Team Leader unusual or possible undesirable exposures. Assist Team Leader in developing methods and improvements for handling claims.
• Settle claims promptly and equitably.
• Obtain releases and timely issue indemnity benefits if due and owing.
• Inform claimants, insureds/customers, or attorney of denial of claim when applicable.
• Assist Team Leader and company attorneys in preparing cases for trial by taking statements. Continue efforts to settle claims before trial.
• Refer claims to subrogation as appropriate.
• Participate in claim file reviews and audits with customer/insured and broker.
• Administer Workers’ Compensation benefits timely and appropriately per Jurisdiction.
• Maintain control of claim’s resolution process to minimize current exposure and future risks.
• Establish and maintain strong customer relations.
• Work all queues and diary in a timely manner.
• Investigate compensability and benefit entitlement.
• Review and approve medical bill payments.
• Manage vocational rehabilitation.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level