ESIS Senior Claims Representative, WC

JOB DESCRIPTION

Are you interested in building your career in workers' compensation and claims support? Join ESIS, a leader in risk management and insurance services, where you can contribute to effective claims handling and support employees during important moments.

Under the direction of the Claims Team Leader, the ESIS Senior Claim Representative investigates and resolves claims promptly, fairly, and in accordance with established best practices.

Duties may include, but are not limited to:


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

This role handles more complex claims and requires strong technical skills.


* Communication: Serve as a primary point of contact for injured workers, employers, medical providers, and other stakeholders, providing clear and professional communication throughout the claims process.


* Investigation: Conduct thorough investigations of claims, 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 the facts of the case and applicable laws.


* Documentation: Maintain detailed and organized claim files, documenting all activities, communications, and decisions in 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 responsive 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 support effective claim outcomes.

QUALIFICATIONS



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


* Jurisdiction and Licensing: Knowledge of California and/or Nevada workers' compensation requirements, along with an active adjuster license or the ability to obtain licensure within a specified timeframe.


* Compliance: Ability to follow legal, regulatory, and company-specific requirements.


* Quality and Performance: Ability to meet quality review standards by following established claims handling procedures.


* ESIS, Client, and Carrier Requirements: Ability to follow ESIS best practices and adhere to client and carrier guidelines to support accurate documentation, claims handling, and service delivery.


* Skills:
+ Strong analytical and problem-solving skills
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