ESIS Senior Claims Representative, WC

About the role

Join ESIS, a leader in risk management and insurance services, where you can help support effective claims handling and contribute to positive outcomes for employees and clients. As a Senior Workers’ Compensation Claim Representative, you will investigate and resolve claims promptly, fairly, and in accordance with established best practices under the direction of the Claims Team Leader.

Responsibilities

• Receive and manage new claim assignments.
• Review claim and policy information to establish the background for investigation and determine the extent of the policy’s obligation to the insured.
• Contact, interview, and obtain statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, and others to gather necessary claim information.
• Arrange for surveys and expert evaluations, as appropriate.
• Evaluate facts obtained through investigation to determine liability and the company’s obligation to the insured under the policy contract.
• Prepare reports related to investigations, settlements, claim denials, and evaluations of involved parties.
• Set reserves within authority limits and recommend reserve changes to the Team Leader.
• Review claim progress and status with the Team Leader and discuss issues and recommended corrective actions.
• Manage litigation files in a timely and appropriate manner.
• Assist the Team Leader in developing methods and process improvements for claims handling.
• Resolve claims promptly and fairly.
• Obtain releases, proofs of loss, or compensation agreements and issue company drafts for claim and expense payments.
• Inform claimants, insureds, customers, agents, or attorneys of claim denials when applicable.
• Assist the Team Leader and company attorneys in preparing cases for trial by arranging witness attendance and taking statements.
• Continue efforts to resolve claims before trial.
• Refer claims to subrogation, as appropriate.
• Participate in claim file reviews and audits with customers, insureds, and brokers.
• Administer benefits in a timely and appropriate manner.
• Maintain control of the claim resolution process to minimize current exposure and future risk.
• Establish and maintain strong working relationships with agents, underwriters, insureds, experts, and other stakeholders.
• Depending on the line of business, additional duties may include:
  • Maintaining system logs.
  • Investigating compensability and benefit entitlement.
  • Reviewing and approving medical bill payments or forwarding them for outside review, as necessary.
  • Managing vocational rehabilitation.

Requirements

• Bachelor’s degree or equivalent work experience required; advanced degree such as an MBA preferred.
• Strong technical knowledge of Workers’ Compensation claims, supported by claims handling experience at ESIS or a similar organization; five or more years of claims handling experience preferred.
• Thorough knowledge of Workers’ Compensation products, services, coverages, and applicable legal principles.
• Knowledge of Workers’ Compensation cost containment programs and strong account management skills.
• Professional insurance designations such as AIC, ARM, AICPCU, or equivalent preferred.
• Ability to plan, organize, and implement business and people management practices, supported by management/technical training, a business or legal curriculum, or equivalent related experience.
• Strong communication and interpersonal skills, with the ability to work effectively with team members, ESIS colleagues at all levels, attorneys, producers, and clients/accounts.
• Demonstrated understanding of team-building principles and the ability to apply them to ongoing and planned activities.
• Ability to evaluate programs and procedures, recommend improvements, and facilitate or lead groups.
• Strong analytical and evaluative thinking skills, with the ability to consider multiple sources of information when forming conclusions and determining next steps.
• Demonstrated professionalism, credibility, and commitment to established strategies and values.
• Creativity, initiative, and self-motivation demonstrated through direct claims handling and related responsibilities.
• Ability to manage priorities and allocate resources effectively in support of timely, high-quality service and long-term claims handling objectives.
• 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

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.

Benefits

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