Description

JOB DESCRIPTION

Are you ready to make a meaningful impact in the field of workers' compensation? Join ESIS, a leader in risk management and insurance services, where your expertise can help create safer workplaces and support employees during critical times. At ESIS, we are committed to delivering exceptional service and innovative solutions, and we seek dedicated professionals to join our dynamic team. If you are looking to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation opportunities and discover how you can contribute to a brighter future for all employees.

We are seeking a skilled Senior Claims Representative to strengthen our team. Reporting to the Claims Team Leader, this role is essential in investigating and managing claims promptly and equitably, in accordance with established best practices.

This is a hybrid position, requiring three days per week in-office.

Position Overview: The ESIS Senior California Claim Representative, under the direction of the Claims Team Leader, investigates and resolves claims efficiently, equitably, and in line with best practice guidelines.

Key Responsibilities:

• Claims Management: Investigate, evaluate, and manage workers' compensation claims from initiation to resolution, ensuring compliance with all relevant laws, regulations, and company policies. As a Senior Claim Representative, you will handle more complex cases that require advanced expertise.
• Communication: Act as the primary contact for injured workers, employers, medical providers, and other stakeholders, ensuring clear and professional communication throughout the claims process.
• Investigation: Conduct comprehensive investigations, 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 case facts and applicable laws.
• Documentation: Maintain organized and detailed 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, ensuring appropriate reserves are established and maintained.
• Compliance: Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
• Customer Service: Deliver exceptional service to clients by addressing inquiries, resolving issues, and providing timely updates on claim status.
• Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.

Requisition #: 31800

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