ESIS Senior Claims Representative, WC

Job Description

Are you interested in building your career in workers' compensation and claims support? Join ESIS, a leader in risk management and insurance services, where you can contribute to effective claims handling and support employees during important moments.

Under the direction of the Claims Team Leader, the ESIS Senior Claim Representative investigates and resolves claims promptly, fairly, and in accordance with established best practices.

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. This role handles more complex claims and requires strong technical skills.
• Communication: Serve as a 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 responsive 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 support effective claim outcomes.

Qualifications

• Experience: 3–5 years of experience handling workers' compensation claims; experience with ESIS or a similar third-party administrator is preferred.
• Jurisdiction and Licensing: Knowledge of California and/or Nevada workers' compensation requirements, along with an active adjuster license or the ability to obtain licensure within a specified timeframe.
• Compliance: Ability to follow legal, regulatory, and company-specific requirements.
• Quality and Performance: Ability to meet quality review standards by following established claims handling procedures.
• ESIS, Client, and Carrier Requirements: Ability to follow ESIS best practices and adhere to client and carrier guidelines to support accurate documentation, claims handling, and service delivery.
• Skills:
  • Strong analytical and problem-solving skills
  • 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 claims handling best practices. This role involves handling more complex claims and requires strong technical and analytical skills.

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. ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS' innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients' unique risk management needs. With more than 70 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry's broadest selections of risk management solutions covering both pre- and post-loss services. The pay range for the role is $71,000 to $104,000. 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 34557
• Job Schedule Full time
• Regular or Temporary Regular
• Job Category Claims Adjusting
• Business Unit United States
• Legal Employer ACE American Insurance Company