ESIS Claims Representative, WC

Claims Representative

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 are dedicated to providing exceptional service and innovative solutions, and we are looking for passionate individuals to be part of our dynamic team. If you are 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!

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

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

Major Duties & Responsibilities:

• Receive and manage claim assignments.
• Review claim and policy information to provide context for investigations and determine the extent of policy obligations, depending on the line of business.
• Contact, interview, and obtain statements from insured parties, claimants, witnesses, medical professionals, attorneys, police officers, and others to secure necessary claim information.
• Inspect and appraise property damage or arrange for appraisal, as required by the line of business.
• Evaluate investigation findings to determine liability and the company's obligations under policy contracts.
• Prepare reports on investigations, settlements, claim denials, and evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader.
• Review claim progress and status with the Team Leader, discussing challenges and recommending solutions.
• Submit unusual or potentially undesirable exposures to the Team Leader and assist in developing improved claim handling methods.
• Resolve claims promptly and equitably.
• Obtain releases, proofs of loss, or compensation agreements and issue payments for claims.
• Inform claimants, insured parties, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial, including arranging witness attendance and taking statements, while continuing efforts to settle claims before trial.
• Refer claims to subrogation as appropriate and arrange for salvage disposition or other recovery proceedings as needed.
• Participate in claim file reviews and audits with customers, insured parties, and brokers.
• Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize exposure and future risks.
• Establish and maintain strong customer relationships.

Additional duties may include, depending on the line of business:

• Maintaining system logs
• Investigating compensability and benefit entitlement
• Reviewing and approving medical bill payments
• Managing vocational rehabilitation

Qualifications

• 25 years of experience handling claims in a relevant line of business.
• Basic knowledge of claims handling processes and familiarity with claims terminology.
• Effective negotiation skills.
• Strong communication and interpersonal abilities to engage positively with claimants, customers, insured parties, brokers, attorneys, and others regarding losses.
• Ability to self-motivate and work independently.
• Knowledge of company products, services, coverage, and policy limits, as well as awareness of the company's claims best practices.
• Understanding of applicable state and local laws.

An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam. The pay range for the role is $67,000 to $83,000. The specific offer will depend on an applicant's skills and other factors. This role may also be eligible to participate in a discretionary annual incentive program. Chubb offers a comprehensive benefits package, more details on which can be found on our careers website.

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 33230
• Job Schedule Full time
• Regular or Temporary Regular
• Job Category Claims Adjusting
• Business Unit United States
• Legal Employer ACE American Insurance Company