ESIS Claims Compliance Specialist, WC

The Compliance Specialist is responsible for ensuring regulatory compliance with Nevada Workers Compensation requirements with knowledge of California regulations considered an asset. Reporting to the Claims Vice President this role manages compliance notices legal communications and regulatory inquiries (primarily from the Department of Insurance). The Compliance Specialist ensures timely and accurate responses tracks and analyzes trends for root cause analysis and supports training initiatives for the claims team.

Key Responsibilities:

Compliance & Notice Management

• Receive acknowledge and respond to all compliance notices penalties and DIR communications in a timely manner.
• Apply jurisdictional knowledge to provide accurate responses collaborating with legal counsel as needed.
• Track and document all notices responses and outcomes for trend analysis and training purposes.

DIR Inquiry & Response Coordination

• Lead the response process for DIR inquiries including gathering information coordinating with adjusters and team leaders and drafting formal responses.
• Set and communicate response deadlines review research conducted by adjusters and finalize submissions.
• Assess cases for negotiation opportunities and consult with management as appropriate.

Penalty & Fine Administration

• Manage all fines and penalties including conducting root cause analysis preparing documentation and overseeing approval workflows.
• Provide feedback and training to adjusters and team leaders based on penalty findings.
• Track penalties and trends and implement process improvements to prevent recurrence.

Incoming Hearing Notices & Legal Mail

• Oversee the intake indexing and distribution of new notices and legal mail to the appropriate adjusters and team leaders.
• Ensure prompt escalation of legal and DIR mail by adjusters with all actions documented in the claim file.
• Track and assign hearings maintain hearing calendars and coordinate document preparation.
• Support adjusters and legal counsel in hearing preparation and follow-up activities.

Appeals & Legal Updates

• Track all appeals and obtain necessary approvals for escalations.
• Monitor and communicate legislative and regulatory changes updating processes and training as required.

Training Support & Reporting

• Serve as a resource for Nevada procedural questions and compliance best practices.
• Lead bi-weekly reviews to share knowledge address issues and identify training needs.
• Maintain comprehensive reports on hearings denials appeals penalties and legal costs for management review.

Audits/Carrier Support

• Review and prepare files for state and carrier audits ensuring compliance with carrier guidelines.
• Provide support with carrier reporting and completion of required carrier forms for reportable claims.
• Participate in special projects as needed such as reserve analysis client-specific projects and audits.

Qualifications:

• In-depth knowledge of Nevada Workers Compensation regulations; California experience is a plus.
• Strong organizational communication and analytical skills.
• Ability to work collaboratively with cross-functional teams and external partners.

Experience in compliance claims or a related field preferred.

• Minimum of 5 years experience in claims administration compliance or regulatory affairs (insurance industry preferred)
• Experience working in claims compliance or regulatory environments (Nevada required; California experience is an asset). Active adjuster license or ability to obtain licensure within a specified timeframe is required
• Strong knowledge of regulatory requirements and compliance processes
• Excellent written and verbal communication skills
• Proven ability to manage multiple priorities and meet deadlines in a fast-paced environment
• High attention to detail and accuracy in documentation and reporting
• Strong analytical and problem-solving skills including root cause analysis
• Experience collaborating with cross-functional teams including adjusters team leaders legal and management
• Proficiency with Microsoft Office Suite (Excel Word Outlook) and claims management systems
• Ability to interpret and apply statutes regulations and legal updates
• Experience with process improvement and training delivery is advantageous
• Demonstrated discretion and professionalism in handling sensitive or confidential information
• Strong organizational and time management skills
• Ability to demonstrate leadership work independently and contribute effectively as part of a team
• Customer service orientation and proactive approach to issue resolution

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 $71000 to $104000. 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.