ESIS Claim Representative, WC

About the role

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 Claim Representative, reporting to the Claims Team Leader, is responsible for investigating and resolving workers’ compensation claims promptly, equitably, and in accordance with established best practices.

Responsibilities

• Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
• 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.
• Conduct thorough investigations, including gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.
• Make timely and accurate decisions regarding claim acceptance, denial, or settlement based on case facts and applicable laws.
• Maintain detailed and organized claim files, documenting all activities, communications, and decisions within the claims management system.
• Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, ensuring appropriate reserves are established and maintained.
• Ensure adherence to state-specific workers’ compensation laws, regulations, and reporting requirements.
• Provide exceptional service to clients by addressing inquiries, resolving issues, and delivering timely updates on claim status.
• Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.

Requirements

• Minimum of 2-3 years of experience handling workers’ compensation claims; prior experience with ESIS or similar third-party administrators is a plus.
• Knowledge of Nevada, California, or Arizona Workers’ Compensation and an active adjuster license or ability to obtain licensure within a specified timeframe.
• An applicable resident or designated home state adjuster’s license is required for handling claims; adjusters without the license will not meet employment requirements.
• ESIS supports independent self-study time and allows up to 4 months to pass the adjuster licensing exam.

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.

Pay

The pay range for this 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.

Benefits

Chubb offers a comprehensive benefits package. More details can be found on the company’s careers website.

About Us

ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. With more than 70 years of experience and offerings in both the U.S. and globally, ESIS delivers one of the industry’s broadest selections of risk management solutions covering both pre- and post-loss services.