ESIS Claims Compliance Specialist, WC

JOB DESCRIPTION

The ESIS Claims Compliance Specialist, Workers' Compensation, is responsible for minimizing penalties in Delaware, New Jersey, New York, and Pennsylvania by ensuring compliance with initial payment requirements, reviewing the causes of EDI penalties, and assessing late medical payment penalties.

This role also reviews state correspondence to create TNC claims for Chubb, supports special projects, prepares files for carrier audits, provides support for open desks, and offers general office assistance.

The specialist implements quality plans, monitors results, and recommends corrective actions as needed.

This position reports to and receives direction from the Claims Manager.

This is a hybrid position, with three days per week in-office.

Key responsibilities include, but are not limited to:


* Reviewing the timeliness of first payments to minimize penalties.


* Reviewing unassigned PAR requests from NYS and state correspondence to ensure proper file setup.


* Preparing and reviewing files for carrier audits to ensure compliance with carrier guidelines.


* Collaborating with the Claims Manager and CVP to improve overall Quality Review (QR) scores, including auditing individual files for compliance with QR guidelines.


* Participating in special projects as assigned.


* Assisting with the preparation of Claims Loss Reports (CLR).


* Completing Executive Loss Summary (ELS) reports, maintaining a log of all reports due, and ensuring timely compliance.


* Supporting the training of new hires and ongoing training for current employees, in partnership with the Learning & Development team and in-house trainers.


* Reviewing the progress and status of claims with the Team Leader, discussing issues, and recommending remedial actions.


* Preparing and submitting reports on unusual or potentially undesirable exposures to the Team Leader.


* Reviewing decisions and hearing reports to ensure timely payment of awards and minimize penalties.


* Supporting the Team Leader in developing methods and improvements for claims handling.


* Assisting the Claims Vice President, Claims Manager, Team Leaders, and Claims Handlers with special projects, including reserve analysis, account-specific projects, closing projects, and audits..

QUALIFICATIONS



* Minimum of five years' experience managing workers' compensation claims, demonstrated through progressive responsibility within the company or a comparable organization.


* Proven ability to work independently with minimal supervision.


* Strong organizational skills and a demonstrated ability to meet deadlines.


* Comprehensive technical knowledge of claims handling processes and related terminology.


* Excellent communication and interpersonal skills, with the ability to build positive relationships with claimants, customers, insureds, brokers, and attorneys.


* Thorough understanding of company products, services, coverages...