ESIS Senior Claims Representative, WC

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 were dedicated to providing exceptional service and innovative solutions and were looking for passionate individuals to be part of our dynamic team. If youre 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!

We are seeking a skilled Senior Claims Representative to enhance our team. Reporting to the Claims Team Leader you will play a vital role in investigating and managing claims promptly and equitably in line with established best practices.

Key Responsibilities:

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

• Experience:Minimum of 3 years of experience handling workers compensation claims; prior experience with ESIS or similar third-party administrators is a plus.
• Knowledge & Licensing:Knowledge of California Workers Compensation and active adjuster license or ability to obtain licensure within a specified timeframe.
• Skills:
  • Strong analytical and problem-solving abilities.
  • 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 claim handling best practices. As a Senior Claim Representative candidate will be responsible for more complex and intricate claims requiring an advanced skillset.

An applicable resident or designated home state adjusters license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESISs 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 $65900 to $111900. The specific offer will depend on an applicants 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 foundon 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.

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 industrys broadest selections of risk management solutions covering both pre- and post-loss services.