ESIS Senior 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 a Senior Claim Representative to support the management of workers' compensation claims.

In this role, you will investigate, evaluate, and resolve claims in a timely and equitable manner in accordance with established guidelines, applicable laws, and company policies.

Responsibilities may include:


* Claims Management: Manage workers' compensation claims from intake through resolution, including more complex files that require advanced judgment and technical expertise.


* 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 claim investigations by gathering statements, reviewing medical records, and analyzing accident reports to assess compensability and liability.


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


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


* Cost Control: Monitor claim costs, including medical expenses, indemnity payments, and legal fees, and ensure 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 claim updates.


* Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to support effective claim resolution.

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 the required timeframe.


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


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


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


* Skills:
+ Strong analytical and problem-solving skills
+ Excellent verbal and written comm...