ESIS Claims Representative, WC

JOB DESCRIPTION

The ESIS Claim Representative, reporting to the Claims Team Leader, is responsible for investigating and resolving claims promptly, equitably, and in accordance with established best practices.

Duties and Responsibilities


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


* Communication: Act as the primary point of contact for injured workers, 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, 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 to clients 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 2-3 years of experience managing workers' compensation claims; experience with ESIS or a similar third-party administrator is preferred.


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


* Skills:
+ Strong analytical and problem-solving skills.
+ Excellent verbal and written communication abilities.
+ Proficiency with claims management systems and Microsoft Office Suite.
+ Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
+ Familiarity with workers' compensation laws, medical terminology, and claim handling best practices.

An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters.

Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims.

ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.

ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients...