ESIS Claims Compliance Specialist, WC

Major Duties & Responsibilities

• Ensure regulatory compliance and operational excellence in claims handling, supporting adjusters and leaders through expert guidance, training, and process improvement.
• Critical in minimizing penalties, optimizing audit outcomes, and maintaining high standards of service and compliance.
• Receive, acknowledge, and respond to all compliance notices, penalties, and DIR communications timely.
• Utilize jurisdictional knowledge to provide appropriate responses, working with counsel as needed.
• Track and document all notices, responses, and outcomes for trend analysis and training.
• Manage all fines/penalties, including root cause analysis, write-ups, and approval workflows.
• Provide feedback and training to adjusters/team leaders based on penalty findings.
• Track penalties, trends, and implement process improvements to prevent recurrence.
• Monitor and communicate legislative/regulatory changes, updating processes and training as required.
• Serve as a resource for Florida and Georgia 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.
• Review and prepare files for State and carrier audits.
• Review files to ensure they are in compliance with carrier guidelines.
• May provide support with carrier reporting and certain carrier forms (reportable claims).
• Lead special projects as deemed necessary such as reserve analysis, client specific projects and audits, etc.

Qualifications

• 5+ years of experience in claims administration, compliance, or regulatory affairs (insurance industry preferred).
• Experience with claims, compliance, or regulatory environments (Florida required).
• 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 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.
• Proven ability to coordinate with cross-functional teams (adjusters, team leaders, legal, management).
• Proficiency with Microsoft Office Suite (Excel, Word, Outlook) and claims management systems.
• Experience with process improvement and training delivery is a plus.
• Experience interpreting and applying statutes, regulations, and legal updates.
• Demonstrated discretion and professionalism in handling sensitive or confidential information.
• Strong organizational and time management skills.
• Ability to demonstrate leadership skills; work independently and as part of a team.
• Customer service orientation and proactive approach to issue resolution.

About Us

Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance, and life insurance to a diverse group of clients. The company is distinguished by its extensive product and service offerings, broad distribution capabilities, exceptional financial strength, underwriting excellence, superior claims handling expertise and local operations globally. At Chubb, we are committed to equal employment opportunity and compliance with all laws and regulations pertaining to it. Our policy is to provide employment, training, compensation, promotion, and other conditions or opportunities of employment, without regard to race, color, religious creed, sex, gender, gender identity, gender expression, sexual orientation, marital status, national origin, ancestry, mental and physical disability, medical condition, genetic information, military and veteran status, age, and pregnancy or any other characteristic protected by law. Performance and qualifications are the only basis upon which we hire, assign, promote, compensate, develop and retain employees. Chubb prohibits all unlawful discrimination, harassment and retaliation against any individual who reports discrimination or harassment.