ESIS Claims Representative, WC

Chubb • Tampa, FL

9d

About The Position

Under direct supervision initially, perform customer service and/or claims functions while training to become a claims representative. Gain exposure to all facets of a professional claims representative position through classroom and hands-on learning. Will be assigned a caseload as training progresses. 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.

Requirements

• 2 years' experience in handling Florida workers compensation claims
• Bachelor’s degree or equivalent experience
• Demonstrated proficiency in claims management systems and the Microsoft Office Suite.
• Excellent written and verbal communication skills, enabling effective interactions with external investigative sources and insureds over the phone.
• Proven ability to contribute effectively within a team environment, providing and receiving constructive feedback while identifying growth opportunities for both self and colleagues.
• Strong analytical and problem-solving abilities to navigate complex scenarios efficiently.
• Capable of managing multiple priorities and meeting deadlines in a fast-paced work environment.
• Strong commitment to customer service, with a proactive approach to addressing and supporting customer needs.
• Confidence in personal judgment, with the ability to support and defend decisions made.
• Dedicated to maintaining high standards of behavior and performance.
• Flexible in adapting approaches and behaviors to fit specific situations effectively.
• Strong focus on building and maintaining a positive image for Chubb and ESIS.

Nice To Haves

• Prior experience at ESIS or similar third-party administrators being advantageous
• Strong familiarity with workers' compensation laws, medical terminology, and best practices in claims handling is preferred.

Responsibilities

• Investigate, evaluate, and manage workers' compensation claims from inception to resolution, ensuring compliance with applicable laws, regulations, and company policies.
• 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.
• Conduct thorough investigations of claims, including gathering 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 the facts of the case and applicable laws.
• Maintain detailed and organized claim files, documenting all activities, communications, and decisions in the claims management system.
• Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees, while ensuring appropriate reserves are established and maintained.
• Ensure adherence to state-specific workers' compensation laws, regulations, and reporting requirements.
• Provide exceptional 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: Entry Level