ESIS Senior Claims Representative, WC
Chubb•Honolulu, HI
•$71,000 - $104,000
About The Position
The ESIS Senior Workers’ Compensation Claim Representative, under the direction of the Claims Team Leader, is responsible for investigating and resolving claims promptly, fairly, and in accordance with established best practices. ESIS is a leader in risk management and insurance services, dedicated to providing exceptional service and innovative solutions. This role offers an opportunity to advance your career in a collaborative environment that values integrity and growth.
Requirements
- Investigating and resolving claims promptly, fairly, and in accordance with established best practices.
- Gathering necessary claim information through contacts, interviews, and statements from various parties.
- Evaluating facts to determine liability and policy obligations.
- Preparing detailed reports on investigations, settlements, denials, and evaluations.
- Setting reserves within authority limits and recommending changes.
- Communicating claim progress and challenges with the Team Leader.
- Submitting unusual exposures to the Team Leader for review.
- Assisting the Team Leader in claim handling improvements.
- Obtaining releases, proofs of loss, or compensation agreements.
- Issuing company drafts for claim payments.
- Communicating claim denials appropriately.
Responsibilities
- Receives assignments and reviews claim and policy information to provide background for investigations, and may determine the extent of the policy’s obligation to the insured, depending on the line of business.
- Contacts, interviews, and obtains statements from insured parties, claimants, witnesses, medical professionals, legal representatives, law enforcement, and other relevant individuals to gather necessary claim information.
- Evaluates facts obtained during investigations to determine the extent of liability and the company’s obligation under the policy contract.
- Prepares reports detailing investigations, settlements, claim denials, and evaluations of involved parties.
- Sets reserves within authority limits and recommends reserve changes to the Team Leader.
- Reviews the progress and status of claims with the Team Leader, discussing challenges and recommending remedial actions.
- Prepares and submits unusual or potentially undesirable exposures to the Team Leader for review.
- Assists the Team Leader in developing methods and improvements for handling claims.
- Resolves claims promptly and fairly.
- Obtains releases, proofs of loss, or compensation agreements, and issues company drafts for claim payments.
- Communicates claim denials to claimants, insured parties, customers, or legal representatives as appropriate.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
