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ESIS, Inc. · 16 hours ago

Senior Claims Representative

Portland, OR

Full-time

Hybrid

Mid, Senior Level

4+ years exp

ESIS, Inc. is a leader in risk management and insurance services, seeking a Senior Claims Representative to investigate and settle claims in the workers' compensation domain. The role involves evaluating claims, preparing reports, and collaborating with the Claims Team Leader to enhance claims handling methods.

InsuranceInsurTechRisk Management

Responsibilities

Under limited supervision, receives assignments and 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 from insured parties, claimants, witnesses, physicians, attorneys, police officers, and other relevant individuals to secure necessary claim information

Evaluates facts supplied by investigation to determine the extent of liability of the insured, if any, and the extent of the company’s obligation to the insured under the policy contract

Prepares reports on investigations, settlements, denials of claims, and individual evaluations of involved parties

Sets reserves within authority limits and recommends reserve changes to the Team Leader

Reviews progress and status of claims with the Team Leader and discusses problems and suggested remedial actions

Prepares and submits to the Team Leader unusual or potentially undesirable exposures

Assists the 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 payment for claims

Informs claimants, insured parties/customers, or attorneys of denial of claim when applicable

Qualification

Workers' compensation claimsCommunication skillsNegotiation skillsInterpersonal skillsCompany productsClaims best practicesSelf-motivation

Required

4 or more years of experience handling workers' compensation claims

Strong communication and interpersonal skills to effectively interact with claimants, customers, insured parties, brokers, attorneys, and others in a positive manner regarding losses

Ability to self-motivate and work independently

Knowledge of company products, services, coverages, and policy limits, along with awareness of the company's claims best practices

Effective negotiation skills