Description

JOB DESCRIPTION

(Focus on New Mexico Claims)

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 the direction of the Claims Team Leader, the ESIS Senior Claim Representative investigates and resolves claims promptly, equitably, and in accordance with established best practice guidelines.

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

Key Responsibilities:

• Claims Management: Investigate, evaluate, and manage workers' compensation claims from initiation to resolution, ensuring compliance with relevant laws, regulations, and company policies. Responsible for handling complex and intricate claims that require advanced expertise.
• Communication: Serve as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, delivering clear and professional communication throughout the claims process.
• Investigation: Conduct thorough investigations by 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 detailed and organized claim files, documenting all activities, communications, and decisions within 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 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.

Requisition #: 26194

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