ESIS Senior Claims Representative, WC

Are you looking to grow your career in workers’ compensation and claims support? 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.

We are seeking a skilled Senior Claims Representative to join our team. Reporting to the Claims Team Leader, this role is responsible for investigating and managing claims in a timely, accurate, and equitable manner, in accordance with established best practices.

The ESIS Senior Claim Representative, under the direction of the Claims Team Leader, investigates and settles claims promptly, equitably and within established best practices guidelines.

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. As a Senior Claim Representative, candidate will be responsible for more complex and intricate, requiring an advanced skillset.
• 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.

• Experience: 4+ years of workers’ compensation claims experience in Nevada or California is preferred. Experience with ESIS or another third-party administrator (TPA), or a bachelor’s degree or equivalent experience, is a plus.
• Judgment: Ability to work independently with limited supervision and exercise sound judgment.
• Industry Knowledge: Familiarity with workers’ compensation laws, medical terminology, and claims handling best practices.
• Technical Skills: Proficiency with claims management systems and Microsoft Office Suite.
• Communication: Excellent communication and interpersonal skills for working with claimants, customers, brokers, attorneys, and other stakeholders.
• Product and Coverage Knowledge: Strong knowledge of the company’s products, services, coverages, and policy limits, along with a solid understanding of claims best practices.
• Regulatory Knowledge: Working knowledge of applicable state and local laws related to the line of business.
• Customer Service: Strong customer service skills and the ability to manage sensitive claims with professionalism and care.
• Compliance: Ensures compliance with all legal, regulatory and company-specific requirements
• Team Collaboration: Ability to work well in a team environment, share feedback, and contribute to a positive, collaborative culture.
• Analytical Skills: Strong analytical and problem-solving skills with the ability to navigate complex situations.
• Organizational Skills: Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Quality Review Performance: Achieves strong quality review scores by adhering to established high standard procedures
• Professional Presence: Follows ESIS Best Practices; adheres to client and carrier guidelines and requirements to ensure accuracy in documentation, claims handling and service delivery.

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.

ESIS, a Chubb company, provides claim and risk management services to a wide variety of commercial clients. ESIS’ innovative best-in-class approach to program design, integration, and achievement of results aligns with the needs and expectations of our clients’ unique risk management needs. With more than 70 years of experience, and offerings in both the U.S. and globally, ESIS provides one of the industry’s broadest selections of risk management solutions covering both pre- and post-loss services.

The pay range for the role is $78,100 to $105,000. 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.