ESIS Claim Representative, WC

Job description

Are you looking to grow your career in workers’ compensation and claims support? Join ESIS, a leader in risk management and insurance services, where you can help support effective claims handling and contribute to positive outcomes for employees and clients. The ESIS Claim Representative, reporting to the Claims Team Leader, is responsible for investigating and resolving claims promptly, equitably, and in accordance with established best practices.

Duties and Responsibilities

Claims Management: Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.

Communication

Act as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, delivering clear and professional communication throughout the claims process.

Investigation

Conduct thorough investigations, 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 case facts and applicable laws.

Documentation

Maintain detailed and organized claim files, documenting all activities, communications, and decisions within the claims management system.

Cost Control

Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, ensuring appropriate reserves are established and maintained.

Compliance

Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.

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.

Qualifications

Experience

Minimum of 2-3 years of experience handling workers' compensation claims; prior experience with ESIS or similar third-party administrators is a plus.

Knowledge & Licensing

Knowledge of Nevada, California or Arizona Workers Compensation and active adjuster license or ability to obtain licensure within a specified timeframe.

Skills

Strong analytical and problem-solving skills. Excellent verbal and written communication abilities. Proficiency with claims management systems and Microsoft Office Suite. Ability to manage multiple priorities and meet deadlines in a fast-paced environment. 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.

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 $62,700 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. The disclosed pay range estimate may be adjusted for the applicable geographic differential for the location in which the position is filled.