ESIS Claims Representative, WC

Job description

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

Qualifications

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).