Esis Proclaim Representative

ESIS ProClaim is seeking an experienced claim adjuster. In this role you will manage commercial auto/trucking and general liability claims.

Under the direction of the Claims Team Leader will manage all aspects of first party and third-party claims. You will assess coverage, investigates facts of third-party claims, secure evidence, assesses, addresses subrogation/recovery/tenders, manage litigation and apportions liability and settles claims at the best outcome within established claim best practices guidelines and client instructions.

Responsibilities include, but are not limited to:

• Determine coverage, conduct a thorough investigation and may determine the extent of the policy's obligation to the insured depending on the line of business.

• Maintain diary system to ensure each file is reviewed on a timely basis.

• Develops, works and shares performance and productivity goals.

• Reviews, analyzes and shares performance results, productivity and audit/quality review results.

• Provides direction to claims professionals to be able to effectively work with defense counsel and litigation working collaboratively, as directed by the client.

• Ensure detailed 90-day Claim Summary Reports are prepared and provide updates to the client on investigation, potential settlement opportunities, claim denials, reservation of rights, third party tenders and recommendations to present at claims review meetings.

• Posts loss and expense reserves in Claims system within authority limits and recommends reserve changes above authority to AVP and/or VP of Claims.

• Reviews progress and status of claims with claims leadership and discusses issues/opportunities/task and remedial actions.

• Prepares and submits to claims leadership all unusual or potentially undesirable exposures such as allegations of bad faith or unfair claim practice allegations.

• Assists Claims Leadership in formulating improvements in claims handling procedures.

• Assist and works with Partnership Leaders on delivering results, attend meetings and claim reviews.

• Reviews and confirms claims professionals have secured the appropriate releases, proofs of loss or compensation agreements and issues company drafts in payments for claims.

• Maintains claims with the appropriate file notes, reports, photos, and documentation within the claim.

• Follows all company and regulatory compliance requirements.

• Updates claim timely with Medicare data and addresses Medicare reporting & interest.

• Meets or exceeds performance goals.