ESIS Claims Representative, WC
About The Position
Are you ready to make a meaningful impact in the world of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. At ESIS, we're dedicated to providing exceptional service and innovative solutions, and we're looking for passionate individuals to be part of our dynamic team. If you're eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere! The ESIS Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.
Requirements
- Minimum of 2-3 years of experience handling workers' compensation claims; prior experience with ESIS or similar third-party administrators is a plus.
- Knowledge of California Workers Compensation and active adjuster license or ability to obtain licensure within a specified timeframe.
- Strong analytical and problem-solving abilities.
- Excellent verbal and written communication skills.
- Proficiency in claims management systems and Microsoft Office Suite.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
- Familiarity with California 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.
Responsibilities
- Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
- 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.
- Conduct thorough investigations of claims, including gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.
- Make timely and accurate decisions regarding claim acceptance, denial, or settlement based on the facts of the case and applicable laws.
- Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.
- Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.
- Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
- Provide exceptional service to clients by addressing inquiries, resolving issues, and delivering timely updates on claim status.
- Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Insurance Carriers and Related Activities
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
