ESIS Workers Compensation Senior Claim Representative

ESIS®, Inc., a Chubb company, provides claim and risk management services to a wide variety of commercial clients.

ESIS’ innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients’ unique risk management needs.

With more than 60 years of experience, and offerings in both the U.S.

and globally, ESIS provides one of the industry’s broadest selections of risk management solutions covering both pre and post-loss services.

Claims Representative-Workers Compensation
– Under the direction of the Claims Team Leader investigates and settles Illinois and Wisconsin Workers Comp claims promptly, equitably and within established best practices guidelines.

MAJOR DUTIES & RESPONSIBILITIES: 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) 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, proofs of loss or compensation agreements and issues company drafts in payments for claims.

• 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 arranging for attendance of witnesses and taking statements.

Continues efforts to settle claims before trial.

• Refers claims to subrogation as appropriate.

May arrange for other recovery proceedings as necessary by line of business.

• May participate in claim file reviews and audits with customer/insured and broker.

• Administers benefits timely and appropriately.

Maintains control of claim’s resolution process to minimize current exposure and future risks
• Establishes and maintains strong customer relations Depending on the line of business, other duties may include:
• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments
• Managing vocational rehabilitationQualifications:DESIRED QUALIFICATIONS:
• 2-5 years of experience handling Illinois and Wisconsin Workers Comp
• Basic knowledge of claims handling and familiarity with claims terminologies
• 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