ESIS Senior Claims Representative, WC

About the role

Join ESIS, a leader in risk management and insurance services, where your skills and talents can help us create safer workplaces and support employees during their times of need. If you are eager to advance your career in a collaborative environment that values integrity and growth, explore our exciting workers' compensation roles today and discover how you can contribute to a brighter future for employees everywhere!

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

• Experience: Minimum of 3-5 years of experience handling workers' compensation claims; prior experience with ESIS or similar third-party administrators is a plus.
• Jurisdiction & Licensing: Knowledge of California and/or Nevada Workers Compensation and active adjuster license or ability to obtain licensure within a specified timeframe.
• Compliance: Ensures compliance with all legal, regulatory and company-specific requirements.
• Quality Review Performance: Achieves strong quality review scores by adhering to established high standard procedures.
• ESIS/Client/Carrier Requirements: Follows ESIS Best Practices; adheres to client and carrier guidelines and requirements to ensure accuracy in documentation, claims handling and service delivery.

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.

Pay

The pay range for the role is $78,100 to $109,400. The specific offer will depend on an applicant’s skills and other factors.

Benefits

Chubb offers a comprehensive benefits package, more details on which can be found on our careers website.

Schedule

This role may also be eligible to participate in a discretionary annual incentive program.

Company Information

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.