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. **KEY OBJECTIVE:** Under the guidance of the Claims Team Leader, the Claims Specialist investigates and resolves claims efficiently, fairly, and in accordance with established best practices. **MAJOR DUTIES & RESPONSIBILITIES:** **Primary responsibilities include, but are not limited to:** - Receive and review new claim assignments. - Analyze claim and policy information to determine coverage and the extent of the company’s obligations. - Conduct interviews and obtain statements (recorded or in person) from insured parties, claimants, witnesses, medical professionals, legal representatives, and law enforcement as needed. - Arrange for surveys and consult with subject matter experts when appropriate. - Evaluate investigative findings to determine liability and coverage under the policy. - Prepare comprehensive reports on investigations, settlements, claim denials, and evaluations. - Set and recommend changes to reserves within established authority limits. - Review claim progress and status with the Team Leader, discussing challenges and recommending solutions. - Manage litigation files in a timely and appropriate manner. - Support the Team Leader in identifying and implementing process improvements. - Resolve claims promptly and equitably. - Obtain necessary documentation such as releases, proofs of loss, or compensation agreements, and issue payments for claims and related expenses. - Communicate claim decisions to claimants, insured parties, agents, or attorneys as appropriate. - Assist in preparing cases for trial, including arranging witness attendance and gathering statements, while continuing efforts to resolve claims prior to trial. - Refer claims for subrogation when applicable. - Participate in claim file reviews and audits with customers, insured parties, and brokers. - Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize current and future exposure. - Build and maintain strong working relationships with customers, agents, underwriters, and experts. **Additional responsibilities, depending on line of business, may include:** - Maintaining system logs. - Investigating compensability and benefit entitlement. - Reviewing and approving medical bill payments or coordinating external reviews as needed. - Managing vocational rehabilitation processes. **SCOPE INFORMATION:** - This position reports directly to the Claims Team Leader or another member of the claims management team. ### Qualifications - Bachelor’s degree or equivalent work experience; advanced degrees (e.g., MBA) are valued. - Extensive technical knowledge and proficiency in Workers’ Compensation claims, demonstrated by at least five years of relevant claims handling experience at ESIS or a comparable organization. - Comprehensive understanding of Workers’ Compensation products, services, coverages, and applicable legal principles. - Familiarity with Workers’ Compensation cost containment programs and proven account management skills. - Professional insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), AICPCU, or similar credentials. - Ability to plan, organize, and implement business and people management practices, supported by completion of management and technical programs, business or legal coursework, or equivalent practical experience. - Strong communication and interpersonal ski…