ESIS Claims Representative, WC

ESIS Claims Representative, WC

Under direct supervision initially, performs customer service and claims functions while training to become a claims representative. Gains exposure to all facets of a professional claims representative role through classroom and hands-on learning. As training progresses, will be assigned a caseload.

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.
• 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 & Education

• Minimum of 2 years of experience handling workers’ compensation claims
• Experience with ESIS or a similar third-party administrator is preferred
• Bachelor’s degree or equivalent experience

Preferred Knowledge and Skills

• Strong knowledge of workers’ compensation laws, medical terminology, and claims handling best practices
• Proficiency in claims management systems and Microsoft Office Suite
• Excellent written and verbal communication skills, including the ability to communicate effectively with external investigative sources and insureds by phone
• Strong teamwork skills, with the ability to give and receive constructive feedback and identify growth opportunities
• Strong analytical and problem-solving abilities
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment
• Strong customer service focus and a proactive approach to supporting customer needs
• Sound judgment and decision-making skills, with the ability to support and defend decisions
• Commitment to high standards of performance and professionalism
• Flexibility to adapt approach and behavior to different situations
• Ability to represent Chubb and ESIS positively

Licensing Requirement

• An applicable resident or designated home state adjuster’s license is required for ESIS Field Claims Adjusters
• Candidates who do not meet the licensing requirement will not meet ESIS employment requirements for handling claims
• ESIS supports independent self-study time and allows up to 4 months to pass the adjuster licensing exam

The pay range for the role is $57,000 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.