- Junior
- Bureau à Alpharetta
ESIS Claims Representative, WC
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!
Under direct supervision initially, performs customer service and/or claims functions while training to become a claims representative. Gains exposure to all facets of a professional claims representative position through classroom and hands on learning. Will be assigned a caseload as training progresses.
Duties may include but are not limited to:
- Claims Management: Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
- Communication: 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.
- Investigation: Conduct thorough investigations of claims, 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 the facts of the case and applicable laws.
- Documentation: Maintain detailed and organized 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, while ensuring appropriate reserves are established and maintained.
- Compliance: Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
- Customer Service: Provide exceptional service to clients by addressing inquiries, resolving issues, and delivering timely updates on claim status.
- Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.
Qualifications
Experience & Education:
A minimum of 2 years' experience in handling workers' compensation claims in Florida or Georgia is preferred, with prior experience at ESIS or similar third-party administrators being advantageous, and/or bachelor’s degree or equivalent experience.
- Industry Knowledge: Strong familiarity with workers' compensation laws, medical terminology, and best practices in claims handling is preferred.
- Technical Skills: Demonstrated proficiency in claims management systems and the Microsoft Office Suite.
- Communication Skills: Excellent written and verbal communication skills, enabling effective interactions with external investigative sources and insureds over the phone.
- Team Collaboration: Proven ability to contribute effectively within a team environment, providing and receiving constructive feedback while identifying growth opportunities for both self and colleagues.
- Analytical Skills: Strong analytical and problem-solving abilities to navigate complex scenarios efficiently.
- Organizational Skills: Capable of managing multiple priorities and meeting deadlines in a fast-paced work environment.
- Customer Focus: Strong commitment to customer service, with a proactive approach to addressing and supporting customer needs.
- Judgment and Decision-Making: Confidence in personal judgment, with the ability to support and defend decisions made.
- Commitment to Excellence: Dedicated to maintaining high standards of behavior and performance.
- Adaptability: Flexible in adapting approaches and behaviors to fit specific situations effectively.
- Positive Representation: Strong focus on building and maintaining a positive image for Chubb and ESIS.
- Skills:
- 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.
- Knowledge: Familiarity with workers' compensation laws, medical terminology, and claim handling best practices.
