ESIS Senior Claims Representative, WC

JOB DESCRIPTION

Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need.

At ESIS, we are dedicated to providing exceptional service and innovative solutions, and we are looking for passionate individuals to be part of our dynamic team.

If you are eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere!

The ESIS Senior California Claim Representative, under the direction of the Claims Team Leader, investigates and resolves claims promptly, equitably, and in accordance with established best practices.

Key responsibilities include:


* Claims Management: Investigate, evaluate, and manage workers' compensation claims from initiation to resolution, ensuring compliance with relevant laws, regulations, and company policies.

The Senior Claim Representative handles more complex cases requiring advanced expertise.


* Communication: Act as the primary point of contact for injured individuals, employers, medical providers, and other stakeholders, delivering clear and professional communication throughout the claims process.


* Investigation: Conduct thorough investigations, including gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.


* Decision-Making: Make timely and accurate decisions regarding claim acceptance, denial, or settlement based on case facts and applicable laws.


* Documentation: Maintain detailed and organized claim files, documenting all activities, communications, and decisions within the claims management system.


* Cost Control: Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.


* Compliance: Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.


* Customer Service: Provide exceptional service by addressing inquiries, resolving issues, and delivering timely updates on claim status.


* Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.

QUALIFICATIONS



* Experience: Minimum of 3-5 years handling workers' compensation claims; prior experience with ESIS or similar third-party administrators is preferred.


* Jurisdiction & Licensing: Knowledge of California Workers' Compensation regulations and an active adjuster license, or the ability to obtain licensure within a specified timeframe.


* Compliance: Ensures compliance with all legal, regulatory, and company-specific requirements.


* Quality...