ESIS Claims Representative, WC

About the role

Under direct supervision initially, customer service and/or claims functions perform while training to become a claims representative. Gains exposure to all facets of a professional claims representative position through classroom and hands-on learning. Will be assigned a caseload as training progresses.

Responsibilities

• Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
• 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.
• Conduct thorough investigations of claims, 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 the facts of the case and applicable laws.
• Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.
• Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while 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.

Qualifications

• 2 years' experience in handling Florida workers compensation claims, with prior experience at ESIS or similar third-party administrators being advantageous, and/or Bachelor’s degree or equivalent experience.
• Strong familiarity with workers' compensation laws, medical terminology, and best practices in claims handling is preferred.
• Demonstrated proficiency in claims management systems and the Microsoft Office Suite.
• Excellent verbal and written communication skills, enabling effective interactions with external investigative sources and insureds over the phone.
• Proven ability to contribute effectively within a team environment, providing and receiving constructive feedback while identifying growth opportunities for both self and colleagues.
• Strong analytical and problem-solving abilities to navigate complex scenarios efficiently.
• Capable of managing multiple priorities and meeting deadlines in a fast-paced work environment.
• Knowledge: Familiarity with workers' compensation laws, medical terminology, and claim handling best practices.

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.

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.