ESIS Claims Representative, WC

Chubb • Phoenix, AZ

1d • Hybrid

About The Position

We are seeking a Claims Representative to enhance our team. This role plays a vital part in investigating and managing claims promptly and equitably, in line with established best practices. This is a hybrid position, with three days per week in-office. Under the direction of the Claims Team Leader, the ESIS California Claim Representative investigates and resolves claims promptly, equitably, and in accordance with established best practice guidelines.

Requirements

• 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.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees