ESIS Claims Representative, WC

JOB DESCRIPTION

Are you looking to grow your career in workers' compensation and claims support? Join ESIS, a leader in risk management and insurance services, where you can help support effective claims handling and contribute to positive outcomes for employees and clients.

ESIS is seeking an experienced Workers' Compensation Claims Representative for the Glen Allen, VA office.

This role is responsible for handling and maintaining workers' compensation claims and conducting file reviews under the general supervision of a manager as part of the ESIS team.

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 3 years of experience handling workers' compensation claims, including claims investigation and adjusting.

Experience in a third-party administrator (TPA) environment is preferred.


* Knowledge & Licensing: Working knowledge of workers' compensation coverage, compensability, principles, and practices, with knowledge of workers' compensation laws and procedures in VA, WV, IN, MI, OH, NC, SC, TN, and/or KY required.

Knowledge of applicable state and local regulations is also required.


* Skills:
+ Ability to work independently and manage a variety of technical subjects.
+ Ability to organize, prioritize, and complete multiple objectives effectively, with strong time management skills.
+ Strong computer skills, including Microsoft Word and Excel.
+ Ability to communicate effectively an...