ESIS Claims Representative, WC

KEY OBJECTIVE:

Responsibilities include investigating claims to determine extent of injury, reserving and effective case management. Utilize medical cost containment measures to control loss dollar pay-out. Review status of claims and develop strategies to effectively manage to conclusion. Consistent delivery of superior customer service.

MAJOR DUTIES & RESPONSIBILITIES:

• Handle multiple demands & priorities, from a variety of sources, simultaneously
• Maintain ESIS Standards & Best Practices
• Adjust claims with the ability to follow company policies and procedures
• Have the ability to effectively and independently manage and maintain a workers compensation pending.
• Handle and resolve conflict effectively
• Meet goals & objectives established by ESIS and the Claims Vice President
• Escalate issues appropriately and follow through
• Be a problem solver with excellent problem resolution skills
• Meet and maintain customer service requirements and have the ability to follow ESIS processes.
• Make sound judgment decisions and have the ability to differentiate information.
• Communicate effectively both written & orally
• Respond to customers appropriately, timely & accurately

• Ability to remain calm and professional during peak periods of activity.

• Handle multiple computer applications and vendor systems to manage caseloads
• Identify and determine short term and long term financial exposures and establish accurate financial reserves to meet Client, ESIS and Carrier expectations
• Effectively and accurately manage large sums of client or carrier funds
• Comply with all statutory reporting and licensing requirements for multiple jurisdictions
• Determine, calculate and issue accurate benefit payments to injured workers, medical providers and vendors in a timely fashion

• Clearly and concisely document the ESIS claim system with activities, investigations and plans in a timely fashion
  

• Qualified candidates must possess experience 5 or more years in managing workers compensation claims investigation/ adjusting, including knowledge of applicable state/local legislation.

• Experience in a third party administrator (TPA) environment is a plus.

• Knowledge of Workers' Compensation laws and procedures are required.

• Candidates must have the ability to work independently, while assimilating various technical subjects, as evidenced by successful completion of a college degree or equivalent practical work experience.

• AIC/CPCU is preferred

• Candidates must also have solid computer software skills (M/S Word, Excel).