Health Claims Handler - Insurance

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. Under direct supervision initially, performs customer service and/or claims functions while training to become a claims representative. Gains exposure to all facets of a professional claims representative position through classroom and hands on learning. Will be assigned a caseload as training progresses.
Claims Management: Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
Serve as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, providing clear and professional communication throughout the claims process.
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.
Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.
Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.
Customer Service: Provide exceptional 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 achieve optimal claim outcomes.
Preferred Qualifications: A minimum of 2 years' experience in handling workers' compensation claims in California is preferred, with prior experience at ESIS or similar third-party administrators being advantageous, and/or Bachelor's degree or equivalent experience.
Strong familiarity with workers' compensation laws, medical terminology, and best practices in claims handling is preferred.
Demonstrated proficiency in claims management systems and the Microsoft Office Suite.
Excellent written and verbal communication skills, enabling effective interactions with external investigative sources and insureds over the phone.
Proven ability to contribute effectively within a team environment, providing and receiving constructive feedback while identifying growth opportunities for both self and colleagues.
Customer Focus: Strong commitment to customer service, with a proactive approach to addressing and supporting customer needs.
Confidence in personal judgment, with the ability to support and defend decisions made.
Dedicated to maintaining high standards of behavior and performance.
Flexible in adapting approaches and behaviors to fit specific situations effectively.
Positive Representation: Strong focus on building and maintaining a positive image for Chubb and ESIS.
Proficiency in claims management systems and Microsoft Office Suite.
Knowledge: Familiarity with workers' compensation laws, medical terminology, and claim handling best practices.

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. S. and globally, ESIS provides one of the industry's broadest selections of risk management solutions covering both pre- and post-loss services.
Chubb offers a comprehensive benefits package, more details on which can be found on our careers website. 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. Job Schedule Full time
Regular or Temporary Regular
Job Category Claims Adjusting
Business Unit United States
Legal Employer ACE American Insurance Company