Senior Claims Representative

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.

Duties may include but are not limited to:

• Receive assignments. 
• Reviews 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. 
• Contacts, interviews, and obtains statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc. to secure necessary claim information. 
• Evaluates facts supplied by investigation to determine extent of liability of the insured, if any, and extend of the company’s obligation to the insured under the policy contract. 
• Prepares reports on investigation, settlements, denials of claims, individual evaluation of involved parties etc. 
• Sets reserves within authority limits and recommends reserve changes to Team Leader. 
• Reviews progress and status of claims with Team Leader and discusses problems and suggested remedial actions. 
• Prepares and submits to Team Leader unusual or possible undesirable exposures. Assists Team Leader in developing methods and improvements for handling claims. 
• Settles claims promptly and equitably. 
• Obtains releases and timely issues indemnity benefits if due and owing. 
• Informs claimants, insureds/customers, or attorney of denial of claim when applicable. 
• May assist Team Leader and company attorneys in preparing cases for trial by taking statements. Continues efforts to settle claims before trial. 
• Refers claims to subrogation as appropriate.
• May participate in claim file reviews and audits with customer/insured and broker. Administers Workers’ Compensation benefits timely and appropriately per Jurisdiction. Maintains control of claim’s resolution process to minimize current exposure and future risks 
• Establishes and maintains strong customer relations 

OTHER DUTIES MAY INCLUDE:

• Working all queues and diary in a timely manner
• Investigating compensability and benefit entitlement 
• Reviewing and approving medical bill payments 
• Managing vocational rehabilitation 

• 5-7 years’ experience handling Workers’ Compensation claims in TX
• Knowledge of claims handling and familiarity with claims terminologies 
• Effective negotiation skills 
• Strong communication and interpersonal skills to be capable of dealing with claimants, customers, insureds, brokers, attorneys etc. in a positive manner concerning losses. 
• Ability to self-motivate and work independently, excels in organization and time management skills 
• Knowledge of company products, services, coverages, and policy limits, along with awareness of the company’s claims best practices and client service instructions
• Knowledge of applicable state and local laws.

An applicable resident or designated home state adjuster’s license is required for ESIS Field Claims Adjusters.  Adjusters that do not fulfill the license requirements will not meet ESIS’s employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.