ESIS Claims Representative, WC

ESIS Claims Representative, WC
Location: Glen Allen, VA

Work Arrangement
This role follows a hybrid schedule of 3 days in office and 1 day remote.

Under direct supervision initially, performs customer service and claims functions while training to become a claims representative. Gains exposure to all facets of a professional claims representative role through classroom and hands-on learning. As training progresses, will be assigned a caseload.

Duties may include, but are not limited to:

• Claims Management: Investigate, evaluate, and manage workers’ compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
• Communication: 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.
• Investigation: Conduct thorough investigations of claims, including gathering statements, reviewing medical records, and analyzing accident reports to determine compensability and liability.
• Decision-Making: Make timely and accurate decisions regarding claim acceptance, denial, or settlement based on the facts of the case and applicable laws.
• Documentation: Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.
• Cost Control: Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.
• Compliance: Ensure adherence to state-specific workers’ compensation laws, regulations, and reporting requirements.
• Customer Service: Provide exceptional service to clients by addressing inquiries, resolving issues, and delivering timely updates on claim status.
• Collaboration: Work closely with internal teams, including legal, medical, and risk management professionals, to achieve optimal claim outcomes.

What You’ll Need

• Qualified candidates must possess experience in managing workers’ compensation claims investigation and adjusting, including knowledge of applicable state and local legislation.
• Experience in a third-party administrator (TPA) environment is a plus.
• Knowledge of VA, WVA, IN, MI, OH, NC, SC, TN, and/or KY workers’ compensation laws and procedures is required.
• Candidates must have the ability to work independently while assimilating various technical subjects, as evidenced by successful completion of a college degree or equivalent practical work experience.
• AIC/CPCU is preferred, and candidates must also have solid computer software skills, including Microsoft Word and Excel.
• Ability to work independently while assimilating various technical components, as evidenced by successful completion of college-level curriculum or equivalent related practical work experience.
• Working knowledge of workers’ compensation coverage, compensability, principles, and practice.
• Three or more years of experience handling workers’ compensation claims.
• Prior experience working in a TPA environment is strongly preferred.
• Ability to determine, calculate, and issue accurate benefit payments to injured workers, medical providers, and vendors in a timely manner.
• Ability to remain calm and professional during peak periods of activity.
• Ability to organize, prioritize, and complete multiple objectives, with effective time management skills; strong computer skills are essential.
• Self-motivation and self-starting capabilities, along with strong communication and interpersonal skills; capable of dealing with accounts, injured workers, attorneys, and associates.
• Ability to assist with national coordination of accounts.
• An applicable resident or designated home state adjuster’s license is required for ESIS Field Claims Adjusters. Adjusters who do not meet 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.

The pay range for the role is $57,000 to $83,000. 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.