ESIS Claims Representative, WC

Chubb•Phoenix, AZ

17h•Hybrid

About The Position

ESIS is seeking a Claims Representative to join their team. This role is responsible for investigating and managing workers' compensation claims promptly and equitably, in line with established best practices. This is a hybrid position, requiring three days per week in the office. The ESIS California Claim Representative, under the direction of the Claims Team Leader, investigates and resolves claims promptly, equitably, and in accordance with established best practice guidelines.

Requirements

Minimum of 2–3 years handling workers' compensation or similar claims.
Understanding of California Workers’ Compensation regulations.
An active adjuster license, or the ability to obtain licensure within a specified timeframe.
Strong analytical and problem-solving skills.
Excellent verbal and written communication abilities.
Proficiency with 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 best practices in claim handling.
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.

Nice To Haves

Experience with ESIS or other third-party administrators is preferred.

Responsibilities

Investigate, evaluate, and manage workers' compensation claims from initiation to resolution, ensuring compliance with relevant laws, regulations, and company policies.
Act as the primary contact for injured workers, employers, medical providers, and other stakeholders, delivering clear and professional communication throughout the claims process.
Conduct thorough investigations, including collecting 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 case facts and applicable laws.
Maintain organized and detailed claim files, documenting all activities, communications, and decisions within the claims management system.
Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, ensuring appropriate reserves are established and maintained.
Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
Provide high-quality 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 achieve optimal claim outcomes.