ESIS Workers Compensation Specialist

The Claim Specialist, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.

MAJOR DUTIES & RESPONSIBILITIES:

Duties may include but are not limited to:

• 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 compensability for high exposure and Employer Liability claims. 
• 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.
• Settles claims promptly and equitably.
• Informs claimants, insureds/customers or attorney of denial of claim when applicable.
•  Manage litigated matters to resolution.
• Refers claims to subrogation as appropriate.  .
• 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

Job Requirements:

• 5 years’ experience handling Workers Compensation claims  
• 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
• Knowledge of company products, services, coverage’s and policy limits, along with awareness of the company’s claims best practices
• Knowledge of applicable state and local laws for Illinois and Wisconsin