ESIS Senior Claims Representative, WC

Join ESIS, a leader in risk management and insurance services, and contribute to work that supports safer workplaces and effective claims outcomes. We are seeking a skilled and collaborative professional to help manage workers’ compensation claims with accuracy, responsiveness, and a strong focus on service.

At ESIS, we value integrity, accountability, and continuous improvement. This role offers the opportunity to work in a team-oriented environment where you can apply your expertise, grow your career, and make a meaningful contribution to our clients and their employees.

Duties may include, but are not limited to:

• Receive and manage new claim assignments.
• Review claim and policy information to establish the background for investigation and determine the extent of the policy’s obligations to the insured, depending on the line of business.
• Contact, interview, and obtain statements, recorded or in person, from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather necessary claim information.
• Arrange surveys and engage experts when appropriate.
• Evaluate facts obtained through investigation to determine the extent of liability, if any, and the company’s obligations under the policy contract.
• Prepare reports related to investigations, settlements, claim denials, and evaluations of involved parties.
• Establish reserves within authority limits and recommend reserve changes to the Team Leader.
• Review claim progress and status with the Team Leader and discuss issues and recommended actions.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and process improvements for claims handling.
• Settle claims promptly and equitably.
• Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
• Inform claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and obtaining statements, while continuing settlement efforts prior to trial.
• Refer claims to subrogation as appropriate.
• Participate in claim file reviews and audits with customers, insureds, and brokers as needed.
• Administer benefits in a timely and appropriate manner and maintain control of the claim resolution process to help minimize current exposure and future risk.
• Build and maintain strong working relationships with agents, underwriters, insureds, experts, and other stakeholders.

Depending on the line of business, additional duties may include:

• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments or forwarding them for outside review as needed
• Managing vocational rehabilitation

Scope Information:

This position reports directly to a Claims Team Leader or another member of claims management.

• Bachelor’s degree from an accredited college or university, or equivalent work experience; advanced degree preferred.
• Strong technical knowledge of workers’ compensation claims, demonstrated through claims handling experience at ESIS or a similar organization. Five or more years of claims handling experience preferred.
• Thorough knowledge of workers’ compensation products, services, and coverages, along with a solid understanding of applicable legal principles. Experience in DE, NJ, NY, and/or PA preferred.
• Knowledge of workers’ compensation cost containment programs and strong account management skills.
• Professional insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), AICPCU, or equivalent preferred.
• Ability to plan, organize, and implement general business and people management practices, supported by management and technical training, a business or legal college-level curriculum, or equivalent practical experience.
• Strong communication and interpersonal skills with the ability to work effectively with team members at all levels of the organization, as well as attorneys, producers, and clients.
• Understanding of team-building principles and how they apply to ongoing and planned activities.
• Ability to evaluate the effectiveness of programs and procedures and identify opportunities for improvement. Ability to facilitate and lead groups.
• Strong analytical and evaluative thinking skills, with the ability to gather and assess information from multiple sources to support sound decision-making.
• Demonstrated professionalism, credibility, and commitment to organizational strategies and values.
• Creativity, initiative, and self-motiv