ESIS Senior Claims Representative, WC

About the role

Join ESIS, a leader in risk management and insurance services, where you can contribute to effective claims handling and support employees during important moments.

Responsibilities

• Investigate, evaluate, and manage workers’ compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
• Serve as a 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 responsive 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 support effective claim outcomes.

Qualifications

• Experience: 3–5 years of experience handling workers’ compensation claims; experience with ESIS or a similar third-party administrator is preferred.
• Jurisdiction and Licensing: Knowledge of California and/or Nevada workers’ compensation requirements, along with an active adjuster license or the ability to obtain licensure within a specified timeframe.
• Compliance: Ability to follow legal, regulatory, and company-specific requirements.
• Quality and Performance: Ability to meet quality review standards by following established claims handling procedures.

Skills

• Strong analytical and problem-solving skills
• 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
• Familiarity with workers’ compensation laws, medical terminology, and claims handling best practices

Benefits

ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. 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.