ESIS Claims Representative, AGL

Manage Auto Liability matters 

• 1st Party Claims

  • Interpret appropriate policy to determine coverage

  • PIP (Med pay), UIM, UM claims

  • Recommend when IME’s would be need. When approved coordinate IME’s through vendor

  • Determine if Medical billing is related to claimed injuries 

  • Speak with claimant related to treatment plans and recommend case management when necessary 

  • Mail all medical bills to vendor to have them looked at for relevancy and fair and customary billing amounts 

  • Payment of appropriate medical bills

  • Determine reportable files per agreement with insurance company and give claim status reports to insurance company

  • ORM Reporting 

    • Determining what claims with ongoing responsibility for medical.

    • Explain why claims need to be reported based on particular no-fault status 

  • MCCA

    • Submit reimbursement requests

    • Determine if certain expenses need prior MCCA approval for payment and seek approval if needed

    • Provide semiannual claim status reports 

• 3rd Party Claims

  • All US claims for bodily injury and property damage (except for MI Mini Tort)

  • Determine if claims can be tendered to events or TNC if indemnity agreement exists

  • Gather claim information 

  • Determine liability based on facts available and applicable state law

  • Assign appraisers when necessary, through Audatex system

  • Review repair estimates and determine if appraisal is needed 

  • Review medical documentation for bodily injury claims

  • Work with ESIS Total Loss Team for total loss of 3rd party vehicles 

  • Negotiate claims with plaintiff counsel or claimant directly for BI and PD claims