Description

JOB DESCRIPTION

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!

ESIS is seeking a Workers' Compensation Team Leader to supervise and guide the activities of Claims Representatives, Specialists, Claims Assistants, and other support staff in the investigation and management of workers' compensation claims. The Team Leader ensures prompt, efficient, and fair claims handling, while maintaining a high standard of customer service and claim file quality.

General Responsibilities:

• Enhance the technical quality of claim files within the team.
• Facilitate team collaboration by removing barriers and actively resolving team issues.
• Serve as a key member of the Claims Office Workers' Compensation Management Team.
• Oversee ongoing team development, effective loss management, and delivery of value-added customer service.
• Foster a strong commitment to team building and ESIS management principles.
• Utilize current information systems effectively.
• Collect and analyze data to identify opportunities for individual improvement.
• Work with team members to assess knowledge and skill gaps, and develop plans for professional growth.
• Promote ESIS Claims Management Division strategies and values.
• Address human resource matters promptly and effectively.
• Take a proactive approach to servicing both external and internal customers.
• Demonstrate expertise in the technical aspects of claims handling.
• Provide one-on-one coaching and guidance to team members.
• Evaluate programs and procedures for continuous improvement.

Specific Responsibilities:

• Review and assign new claims based on customer needs and claim complexity.
• Set initial reserves and provide direction to representatives, identifying issues related to compensability, medical conditions, subrogation, and more.
• Ensure all coding and documentation meet required standards.
• Monitor files according to system and individual claim file diaries, considering file complexity and customer agreements.
• Review files at key checkpoints for investigation, medical management, subrogation, statutory requirements, reserve accuracy, fraud indicators, and provide guidance on ESIS best practices and account requirements.
• Participate in account discussions regarding escalated file issues.
• Review status reports for accounts and participate in file reviews as needed.
• Manage overall team performance, including attendance, file quality, service, and interpersonal matters.
• Ensure reserve adequacy in compliance with ESIS and carrier requirements.
• Participate in litigation strategy sessions.
• Review and correct internal documents (reserves, appeals, audit requirements, etc.), and complete them as necessary.
• Collaborate in the strategy and management of catastrophic injuries with accounts, nurses, representatives, claims leadership, the home office, and carriers.
• Conduct quality audits and individual claim file reviews.
• Provide feedback and responses to carrier, customer, and broker reviews.
• Coordinate training for the team and office on jurisdictional, medical, procedural, carrier, and account requirements.
• Address concerns from customers, claimants, brokers, or carriers that escalate beyond the representative.
• Balance caseloads among team members and across the office.
• Train new hires in all aspects of claims handling.
• Oversee the timely and accurate closure of cases.

Requisition #: 29711

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