ESIS Claims Representative, WC

Job Title

Investigator

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

• Qualified 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).

About Us

Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.

Job Info

• Job Identification 33667
• Job Schedule Full time
• Regular or Temporary Regular
• Job Category Claims Adjusting
• Business Unit United States
• Legal Employer ACE American Insurance Company