ESIS Claims Representative, WC

Chubb•Tampa, FL

About The Position

Under close supervision, receive assignments and review claim and policy information to provide background for investigation and may determine the extent of the policy’s obligation to the insured, depending on the line of business. Contact, interview, and obtain statements (recorded or in person) from insureds, claimants, witnesses, physicians, attorneys, police officers, etc., to secure necessary claim information. Evaluate facts supplied by the investigation to determine the extent of liability of the insured, if any, and the extent of the company’s obligation to the insured under the policy contract. Prepare reports on investigations, settlements, denials of claims, and individual evaluations of involved parties. Set reserves within authority limits and recommend reserve changes to the Team Leader. Review progress and status of claims with the Team Leader and discuss problems and suggested remedial actions. Prepare and submit to the Team Leader any unusual or potentially undesirable exposures. Assist the Team Leader in developing methods and improvements for handling claims. Settle claims promptly and equitably. Obtain releases, proofs of loss, or compensation agreements and issue company drafts for payments on claims. Inform claimants, insureds/customers, or attorneys of claim denials when applicable. Assist the Team Leader and company attorneys in preparing cases for trial by arranging for witness attendance and taking statements. Continue efforts to settle claims before trial. Participate in claim file reviews and audits with customers/insureds and brokers. Administer benefits timely and appropriately. Maintain control of the claims resolution process to minimize current exposure and future risks.

Requirements

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

1-3 years' experience in handling workers' compensation claims in Florida/Georgia/Alabama is preferred.
Prior experience at ESIS or similar third-party administrators being advantageous.
Bachelor’s degree or equivalent experience.
Strong familiarity with workers' compensation laws, medical terminology, and best practices in claims handling is preferred.

Responsibilities

Receive assignments and review claim and policy information to provide background for investigation.
Determine the extent of the policy’s obligation to the insured.
Contact, interview, and obtain statements from insureds, claimants, witnesses, physicians, attorneys, police officers, etc.
Evaluate facts supplied by the investigation to determine the extent of liability of the insured and the company’s obligation.
Prepare reports on investigations, settlements, denials of claims, and individual evaluations.
Set reserves within authority limits and recommend reserve changes to the Team Leader.
Review progress and status of claims with the Team Leader and discuss problems and suggested remedial actions.
Prepare and submit any unusual or potentially undesirable exposures to the Team Leader.
Assist the Team Leader in developing methods and improvements for handling claims.
Settle claims promptly and equitably.
Obtain releases, proofs of loss, or compensation agreements and issue company drafts for payments.
Inform claimants, insureds/customers, or attorneys of claim denials.
Assist the Team Leader and company attorneys in preparing cases for trial.
Participate in claim file reviews and audits with customers/insureds and brokers.
Administer benefits timely and appropriately.
Maintain control of the claims resolution process to minimize current exposure and future risks.