ESIS Senior Claims Representative, WC

Key Objective

Under the guidance of the Claims Team Leader, the Claims Specialist investigates and resolves claims efficiently, fairly, and in accordance with established best practices.

Major Duties & Responsibilities

Primary responsibilities include, but are not limited to:

• Receive and review new claim assignments.
• Analyze claim and policy information to determine coverage and the extent of the company's obligations.
• Conduct interviews and obtain statements (recorded or in person) from insured parties, claimants, witnesses, medical professionals, legal representatives, and law enforcement as needed.
• Arrange for surveys and consult with subject matter experts when appropriate.
• Evaluate investigative findings to determine liability and coverage under the policy.
• Prepare comprehensive reports on investigations, settlements, claim denials, and evaluations.
• Set and recommend changes to reserves within established authority limits.
• Review claim progress and status with the Team Leader, discussing challenges and recommending solutions.
• Manage litigation files in a timely and appropriate manner.
• Support the Team Leader in identifying and implementing process improvements.
• Resolve claims promptly and equitably.
• Obtain necessary documentation such as releases, proofs of loss, or compensation agreements, and issue payments for claims and related expenses.
• Communicate claim decisions to claimants, insured parties, agents, or attorneys as appropriate.
• Assist in preparing cases for trial, including arranging witness attendance and gathering statements, while continuing efforts to resolve claims prior to trial.
• Refer claims for subrogation when applicable.
• Participate in claim file reviews and audits with customers, insured parties, and brokers.
• Administer benefits in a timely and appropriate manner, maintaining control of the claim resolution process to minimize current and future exposure.
• Build and maintain strong working relationships with customers, agents, underwriters, and experts.

Additional Responsibilities

Depending on line of business, may include:

• Maintaining system logs.
• Investigating compensability and benefit entitlement.
• Reviewing and approving medical bill payments or coordinating external reviews as needed.
• Managing vocational rehabilitation processes.

Scope Information

This position reports directly to the Claims Team Leader or another member of the claims management team.

Qualifications

• Bachelor's degree or equivalent work experience; advanced degrees (e.g., MBA) are valued.
• Extensive technical knowledge and proficiency in Workers' Compensation claims, demonstrated by at least five years of relevant claims handling experience at ESIS or a comparable organization.
• Comprehensive understanding of Workers' Compensation products, services, coverages, and applicable legal principles.
• Familiarity with Workers' Compensation cost containment programs and proven account management skills.
• Professional insurance designations such as Associate in Claims (AIC), Associate in Risk Management (ARM), AICPCU, or similar credentials.
• Ability to plan, organize, and implement business and people management practices, supported by completion of management and technical programs, business or legal coursework, or equivalent practical experience.
• Strong communication and interpersonal skills, enabling effective collaboration with colleagues, attorneys, producers, and clients at all organizational levels.
• Understanding of team-building principles and their application to ongoing and planned activities.
• Ability to evaluate the effectiveness of programs and procedures, recommend improvements, and facilitate group activities.
• Demonstrated evaluative thinking, including the ability to seek out and consider multiple sources of information to inform decisions and actions.
• Commitment to personal effectiveness, credibility, and alignment with organizational strategies and values.
• Demonstrated creativity and self-motivation through active engagement in claims handling and related functions.
• Ability to manage activities and resource allocation to ensure timely, high-quality service and support long-term objectives related to claims processing.
• An applicable resident or designated home state adjuster's license is required for ESIS Field Claims Adjusters. Adjusters that do not fulfill the license requirements will not meet ESIS's employment requirements for handling claims. ESIS supports independent self-study time and will allow up to 4 months to pass the adjuster licensing exam.

Pay & Benefits

• The pay range for the role is $71,000 to $104,000. 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.