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.

Under direct supervision initially, performs customer service and/or claims functions while training to become a claims representative.

Gains exposure to all facets of a professional claims representative position through classroom and hands on learning.

Will be assigned a caseload as training progresses.

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.


* Communication: Serve as the 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 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



* Preferred Qualifications: A minimum of 2 years' experience in handling workers' compensation claims in California is preferred, with prior experience at ESIS or similar third-party administrators being advantageous, and/or Bachelor's degree or equivalent experience.


* Industry Knowledge: Strong familiarity with workers' compensation laws, medical terminology, and best practices in claims handling is preferred.


* Technical Skills: Demonstrated proficiency in claims management systems and the Microsoft Office Suite.


* Communication Skills: Excellent written and verbal communication skills, enabling effective interactions with external investigative sources and insureds over the phone.


* Team Collaboration: Proven ability to contribute effectively within a team environment, providin...