ESIS Senior Claims Representative, WC

About the role

As a Workers’ Compensation Senior Claims Representative, you will investigate and settle claims promptly, equitably, and within established best practices guidelines under the direction of the Claims Team Leader.

Responsibilities

• Receive assignments and review claim and policy information to determine the extent of the policy’s obligation to the insured.
• Contact, interview, and obtain statements from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to secure necessary claim information.
• Evaluate facts to determine the extent of liability of the insured and the company’s obligation under the policy contract.
• Prepare reports on investigations, settlements, denials of claims, and individual evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader.
• Review progress and status of claims with the Team Leader and discuss problems and suggested remedial actions.
• Prepare and submit unusual or potentially undesirable exposures to the Team Leader.
• Assist the Team Leader in developing methods and improvements for handling claims.
• Settle claims promptly and equitably, obtaining releases and issuing indemnity benefits if due and owing.
• Inform claimants, insureds, customers, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial by taking statements and continuing efforts to settle claims before trial.
• Refer claims to subrogation as appropriate.
• Participate in claim file reviews and audits with customers, insureds, and brokers.
• Administer Workers’ Compensation benefits timely and appropriately per jurisdiction.
• Maintain control of the claim’s resolution process to minimize current exposure and future risks.
• Establish and maintain strong customer relations.
• Work all queues and diary in a timely manner.
• Investigate compensability and benefit entitlement.
• Review and approve medical bill payments.
• Manage vocational rehabilitation.

Requirements

• 3-5 years’ experience handling Workers’ Compensation claims.
• Knowledge of claims handling and familiarity with claims terminologies.
• Effective negotiation skills.
• Strong communication and interpersonal skills to deal positively with claimants, customers, insureds, brokers, and attorneys.
• Ability to self-motivate and work independently, with strong organization and time management skills.
• Knowledge of company products, services, coverages, policy limits, and awareness of claims best practices and client service instructions.
• Knowledge of applicable state and local laws.
• Experience in any of the jurisdictions serviced in the region (MD, DC, VA, NC, SC, TN, KY, WV, OH, IN, MI) is preferred but not required.
• 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.

About Us

ESIS, a multi-line Third-Party Administrator (TPA), provides claims, risk control, and loss information systems to Fortune 1000 clients across its North American platform. ESIS offers a full range of sophisticated risk management services, including workers compensation claims handling; a broad spectrum of casualty insurance products such as general liability, automobile liability, products liability, professional liability, and medical malpractice claims handling; and disability management.

ESIS is part of Chubb, 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.