ESIS Claims Representative, WC

ESIS Claims Representative, WC, Dallas, Texas

Key Objective:
Investigate workers’ compensation claims to determine the extent of injury, establish accurate reserves, and manage cases effectively through resolution. Use medical cost containment strategies to help control loss costs while delivering consistent, high-quality customer service.

Major Duties & Responsibilities:

• Manage multiple priorities and demands from various sources simultaneously
• Maintain ESIS standards and best practices
• Adjust claims in accordance with company policies and procedures
• Independently manage a workers’ compensation pending caseload
• Resolve conflict effectively and professionally
• Meet goals and objectives established by ESIS and the Claims Vice President
• Escalate issues appropriately and follow through to resolution
• Apply strong problem-solving and issue-resolution skills
• Meet customer service expectations and follow ESIS processes
• Exercise sound judgment and distinguish relevant information
• Communicate clearly and effectively, both verbally and in writing
• Respond to customers promptly, accurately, and professionally
• Remain calm and professional during periods of high activity
• Use multiple computer applications and vendor systems to manage caseloads
• Identify short- and long-term financial exposures and establish accurate reserves in line with client, ESIS, and carrier expectations
• Manage large sums of client or carrier funds accurately and effectively
• Comply with statutory reporting and licensing requirements across multiple jurisdictions
• Determine, calculate, and issue accurate benefit payments to injured workers, medical providers, and vendors in a timely manner
• Document claim activity, investigations, and action plans clearly, concisely, and promptly in the ESIS claim system

• Candidates must have 5 or more years of experience managing workers’ compensation claims investigations and adjusting, including knowledge of applicable state and local legislation.
• Experience in a third-party administrator (TPA) environment is a plus.
• Knowledge of workers’ compensation laws and procedures is required.
• Candidates must be able to work independently and assimilate technical subject matter, as demonstrated by a college degree or equivalent practical work experience.
• AIC or CPCU designation is preferred.
• Candidates must have strong computer skills, including Microsoft Word and Excel.